Venous thrombotic, thromboembolic, and mechanical complications after retrievable inferior vena cava filters for major trauma

Ho, Kwok M.; Tan, Jason; Burrell, Maxine; Rao, Sudhakar; Misur, Philip

doi:10.1093/bja/aeu195

Cited by 32 publications

(18 citation statements)

References 16 publications

(6 reference statements)

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“…This has been observed in other studies, as well, showing that utilization and retrieval rates as potential quality of care issues and deserve dedicated interventions to ensure quality outcomes for patients. 30–32 …”

Section: Discussionmentioning

confidence: 99%

Hospital Variation and Patient Characteristics Associated With Vena Cava Filter Utilization

Brown

Talbert²

2017

Medical Care

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Introduction There is wide variation in the use of vena cava filter (VCFs). Objectives This study assessed the hospital and patient characteristics associated with VCF use in deep vein thrombosis (DVT) and pulmonary embolism (PE). Methods Inpatient discharge data from all acute care hospitals with DVT/PE during 2008–2014 in Kentucky were used. Hierarchical logistic regression models were used to evaluate the relationships of study variables with VCF use. Results During the study period, 81,922 discharges for DVT/PE were observed and 10.5% of these received a VCF. This included 12,083 cases of PE+DVT, 18,571 cases of PE only, and 51,268 cases of DVT only. VCF use among these groups was 22.7%, 6.0%, and 7.8%, respectively. In adjusted analyses, VCF use was associated with increasing age, indicating that those over age 65 were twice as likely to receive a filter compared to the reference (21–25 year-old) group. Significant comorbidities associated with VCF use included cancer, liver disease, cerebrovascular disease, atrial fibrillation, anemia, and concurrent bleeding. Lower extremity, proximal DVTs, and patients receiving thrombolytic therapy or embolectomy, those having surgery, and those who were unstable or had trauma, were also more likely to receive a filter. Among cancer types, brain and metastatic tumors were significantly associated with VCF use. Between-hospital variation after controlling for all covariates was 7.1%. Conclusion There was high variation in use of VCFs. Several high-risk subgroups were more likely to use VCFs including older adults and those with cancer and concurrent bleeding.

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Section: Discussionmentioning

confidence: 99%

Hospital Variation and Patient Characteristics Associated With Vena Cava Filter Utilization

Brown

Talbert²

2017

Medical Care

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“…[ 28 ] In the present cohort, the rates of these mechanical complications were lower than those reported previously; where the incidence of mechanical complications documented in the previous series was around 9%. [ 28 29 ]…”

Section: Discussionmentioning

confidence: 99%

Indications, retrieval rate, and complications of inferior vena cava filters: Single-center experience in Saudi Arabia

et al. 2018

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BACKGROUND:Inferior vena cava (IVC) filter is indicated in patients with acute venous thromboembolism (VTE) in whom therapeutic anticoagulation is contraindicated. While prophylactic insertion of an IVC filter may be considered for patients at high risk of VTE, there are significant differences between clinical guidelines on the role of IVC filters. These discrepancies have arisen predominantly because of the paucity of data on the efficacy and safety of IVC filters. We, therefore, evaluated the indications for filter insertion, the rate of filter retrieval and complications in patients who received IVC filters at King Abdulaziz Medical City (KAMC), Riyadh, Saudi Arabia.METHODS:A descriptive, retrospective review of electronic- and paper-based medical records was performed. Consecutive sampling was used to study all adult patients who received an IVC filter at KAMC between 2007 and 2016 and met the inclusion criteria.RESULTS:A total of 382 IVC filters were inserted. 113 patients (30%) had an acute VTE and a contraindication to anticoagulation while 53 patients (14%) received an IVC filter in the absence of VTE (i.e., prophylactic). Only 124 (32.5%) IVC filters were eventually retrieved. The most common reason for nonretrieval was the need for permanent filtration (155, 60%). Thrombotic complications developed in 72 (19%) patients; nine patients had fatal pulmonary embolism.CONCLUSION:The insertion of IVC filters in this cohort was associated with low retrieval rate and relatively high incidence of thrombotic complications. Follow-up of patients is required to detect IVC filter-related complications and to increase retrieval rate.

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“…Unfortunately, follow-up of trauma patients is notoriously challenging and concerns about the rate of filter retrieval and potential long-term complications for those left in place remain. A recent retrospective study of IVCFs placed in trauma patients found the risk of mechanical complications including adherence to the IVC wall, filter thrombus, and displaced or tilted filter increased substantially when filters were in place 950 days [37]. This single center study included 223 patients in whom 10 % of IVCFs were placed due to acute VTE and a contraindication to anticoagulation while the remaining 90 % were placed prophylactically.…”

Section: Research In Indicationsmentioning

confidence: 99%

Inferior Vena Cava Filters: Indications, Outcomes, and Evidence

Montgomery

Kaufman

2015

Curr Treat Options Cardio Med

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Filter technology seems relatively stable, although absorbable devices are an area of investigational interest. The indications for filter placement remain controversial, with wide variations in adherence to guidelines, and relatively poor quality of data about the specific prophylactic indications of trauma or bariatric surgery. The outcomes of filters are not well-defined despite widespread clinical use, and good data remains difficult to obtain. Several larger database and institutional retrospective studies support the notions that while filters prevent pulmonary embolism, they may be associated with venous thrombotic complications. Some subsets of cancer patients may be at increased risk of these complications, but whether the filter or the underlying hypercoagulable state is the cause is not clear. Lastly, although the benefits of filter retrieval are widely assumed (but not proven), filter retrieval rates remain lower than expected. The single most influential factor in improving filter retrieval rates is dedicated follow-up with intent to retrieve the filter.

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Venous thrombotic, thromboembolic, and mechanical complications after retrievable inferior vena cava filters for major trauma

Abstract: A delay in initiating pharmacological thromboprophylaxis or filter removal were associated with an increased risk of subsequent DVT, VTE, and mechanical complications of retrievable IVC filters in patients after major trauma.

Cited by 32 publications

References 16 publications

Hospital Variation and Patient Characteristics Associated With Vena Cava Filter Utilization

Hospital Variation and Patient Characteristics Associated With Vena Cava Filter Utilization

Indications, retrieval rate, and complications of inferior vena cava filters: Single-center experience in Saudi Arabia

Inferior Vena Cava Filters: Indications, Outcomes, and Evidence

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