High utilization rate of vena cava filters in deep vein thrombosis

Michael R. Jaff; Samuel Z. Goldhaber; Victor F. Tapson

doi:10.1160/TH04-10-0645

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2005; 93(06): 1117-1119
DOI: 10.1160/TH04-10-0645

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

High utilization rate of vena cava filters in deep vein thrombosis

Authors

Michael R. Jaff

¹Massachusetts General Hospital, Boston, Massachusetts, USA
Samuel Z. Goldhaber

²Brigham and Women's Hospital, Boston, Massachusetts, USA
Victor F. Tapson

³Duke University Medical Center, Durham, North Carolina, USA

Abstract

Summary

The objective was to investigate newly diagnosed patients with deep vein thrombosis (DVT) who received inferior vena cava filters (IVCFs). A prospective registry enrolled 5451 patients from 183 US study sites. In all patients, examination by venous duplex ultrasound confirmed the diagnosis of DVT. We collected and analyzed data on 781 patients who received an IVCF . The most frequently prescribed treatments were low–molecular-weight heparin and unfractionated heparin, which were used as a bridge to warfarin in 39% (n=2143) and 35% (n=1926) of patients, respectively. Of the total population, 781 (14%) (235 outpatients, 546 inpatients) underwent IVCF placement. The most common reasons for IVCF placement were contraindication to anticoagulation (n = 271), prophylaxis (n = 259), major bleeding related to anticoagulation therapy (n = 92), and anticoagulation failure (n = 73). Multivariate analysis revealed that patients were more likely to undergo IVCF insertion with multiple system organ failure (odds ratio [OR], 3.6; 95% CI, 1.48–8.60), previous stroke (OR, 3.2; 95% CI, 2.11–4.74), or history of pulmonary embolism (OR, 2.4; 95% CI, 1.95–2.91). In conclusion, a surprisingly high 14% (781) of patients with confirmed DVT received an IVCF. Many of these patients may have warranted less invasive methods of venous thromboembolism prophylaxis. Improved physician education regarding mechanical and pharmacologic prophylaxis alternatives might reduce the use of IVCFs.

Keywords

Deep vein thrombosis - pulmonary embolism - heparins / glycosaminoglycans - intravascular devices

Full Text

References

References
1 Buller HR, Agnelli G, Hull RD. et al. Antithrombotic therapy for venous thromboembolic disease. Chest 2004; 126: 401S-428S.
2 Goldhaber SZ, Tapson VF. for the DVT FREE Steering Committee. A prospective registry of 5,451 patients with ultrasound-confirmed deep vein thrombosis. Am J Cardiol 2004; 93: 259S-428S.
3 Stein PD, Kayali F, Olson RE. Twenty-one year trends in the use of Inferior Vena Cava Filters. Arch Intern Med 2004; 164: 1541-5.
4 Ray CE, Kaufman JA. Complications of inferior vena cava filters. Abdom Imaging 1996; 21: 368-74.
5 Ballew KA, Philbrick JT, Becker DM. Vena cava filter devices. Clin Chest Med 1995; 16: 295-305.
6 Kinney TB. Update on inferior vena cava filters. J Vasc Interv Radiol 2003; 14: 425-40.
7 Streiff MB. Vena cava filters: a comprehensive review. Blood 2000; 95: 3669-77.
8 Molgaard CP, Yucel EK, Geller SC. et al. Accesssite thrombosis after placement of inferior vena cava filters with 12–14-F delivery sheaths. Radiology 1992; 185: 257-61.
9 Athanasoulis CA, Kaufman JA, Halpern EF. et al. Inferior vena caval filters: review of a 26-year singlecenter clinical experience. Radiology 2000; 216: 54-66.
10 White RH, Zhou H, Kim J. et al. A population-based study of the effectiveness of inferior vena cava filter use among patients with venous thromboembolism. Arch Intern Med 2000; 160: 2033-41.
11 Goldhaber SZ. Pulmonary embolism. N Engl J Med 1998; 339: 93-104.
12 Kim V, Spandorfer J. Epidemiology of venous thromboembolic disease. Emerg Med Clin North Am 2001; 19: 839-59.
13 Decousus H, Leizorovicz A, Parent F. et al. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. N Engl J Med 1998; 338: 409-15.
14 Yamagami T, Kato T, Iida S. et al. Retrievable vena cava filter placement during treatment f deep venous thrombosis. Br J Radiol 2003; 76: 712-8.
15 Ponchon M, Goffette P, Hainaut P. Temporary vena caval filtration. Preliminary clinical experience with removable vena caval filters. Acta Clin Belg 1999; 54: 223-8.
16 Rochelson B, Scher L, Warshawsky R. et al. Use of a temporary vena cava filter in a woman with septic abortion and inferior vena cava thrombosis. A case report. J Reprod Med 2003; 48: 557-9.
17 Linsenmaier U, Rieger J, Schenk F. et al. Indications, management, and complications of temporary inferior vena cava filters. Cardiovasc Intervent Radiol 1998; 21: 464-9.
18 Ishikura K, Yamada N, Oota M. et al. Clinical experience with retrievable vena cava filters for prevention of pulmonary thromboembolism. J Cardiol 2002; 40: 267-73.
19 Asch MR. Initial experience in humans with a new retrievable inferior vena cava filter. Radiology 2002; 225: 835-44.