Guideline Compliance and Indications for Inferior Vena Cava Filter Placement at a Quaternary Care Medical Center

Abstract

Purpose:

This study investigated physician compliance with indications for inferior vena cava (IVC) filter placement according to the 2012 American College of Chest Physicians (ACCP) and the 2011 Society of Interventional Radiology (SIR) guidelines.

Materials and Methods:

A retrospective medical record review of 231 retrievable IVC filters placed between August 15, 2016, and December 28, 2017, at a large urban academic medical center. Guideline compliance to the 2012 ACCP and the 2011 SIR guidelines, and indications for IVC filter placements were assessed through an adjudication protocol. Filter retrieval and complication rates were also examined.

Results:

Compliance to guidelines was low (60.2% for ACCP; 74.0% for SIR), especially for non-intensive care unit (ICU) patients (ICU 74.6% vs non-ICU 54.8%, p=0.007 for ACCP; ICU 82.5% vs non-ICU 70.8%, p=0.092 for SIR). After adjudication, 8.2% (19/231) of filters were considered non-indicated but reasonable, 17.7% (41/231) non-indicated and unreasonable, and 13.9% (32/231) SIR-indicated but not ACCP-indicated. The most common indication was venous thromboembolism with contraindication to anticoagulation. The most common reasons for non-compliance were distal deep venous thrombosis with contraindication to anticoagulation (19/60, 31.6%) and clot burden (19/60, 31.6%). One-year filter retrieval and 90-day complication rates were 32.0% (74/231) and 6.1% (14/231), respectively.

Conclusion:

Compliance to established guidelines was low. Reasons for non-compliance included limitations or discrepancies in guidelines, as well as non–evidence-based filter placements.

Clinical Impact

Despite increasing utilization of inferior vena cava (IVC) filters, guideline compliance for IVC filter placement among providers is unclear. The results of this study indicate that physician compliance to established guidelines is poor, especially in non-intensive-care-unit patients. Noncompliance stems from non-evidence-based filter placement as well as differences and limitations in guidelines. Avoiding non-indicated IVC filter placement and consolidation of guidelines may significantly improve guideline compliance. The critical insights gained from this study can help promote judicious use of IVC filters and highlight the role of venous thromboembolism experts in navigating complex cases and nuances of guidelines.

Keywords

caval filters venous thromboembolism deep vein thrombosis pulmonary embolism guidelines

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References

Beckman

Hooper

Critchley

, et al. Venous thromboembolism: a public health concern. Am J Prev Med. 2010;38(4)(suppl):S495–S501.

Wells

Forgie

Rodger

MA.

Treatment of venous thromboembolism. JAMA. 2014;311(7):717–728.

Benjamin

Muntner

Alonso

, et al. Heart disease and stroke statistics—2019 update: a report from the American Heart Association. Circulation. 2019;139(10):e56–e528.

Angel

Tapson

Galgon

, et al. Systematic review of the use of retrievable inferior vena cava filters. J Vasc Interv Radiol. 2011;22(11):1522–1530.e3.

Minocha

Smith

Kapoor

, et al. ACR appropriateness criteria(®) radiologic management of venous thromboembolism-inferior vena cava filters. J Am Coll Radiol. 2019;16(5s):S214–S226.

Caplin

Nikolic

Kalva

, et al. Quality improvement guidelines for the performance of inferior vena cava filter placement for the prevention of pulmonary embolism. J Vasc Interv Radiol. 2011;22(11):1499–1506.

Kearon

Akl

Comerota

, et al. Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2)(suppl):e419S–e496S.

Kaufman

Barnes

Chaer

, et al. Society of interventional radiology clinical practice guideline for inferior vena cava filters in the treatment of patients with venous thromboembolic disease: developed in collaboration with the American College of Cardiology, American College of Chest Physicians, American College of Surgeons Committee on Trauma, American Heart Association, Society for Vascular Surgery, and Society for Vascular Medicine. J Vasc Interv Radiol. 2020;31(10):1529–1544.

Stevens

Woller

Kreuziger

, et al. Antithrombotic therapy for VTE disease: second update of the CHEST guideline and expert panel report. Chest. 2021;160(6):e545–e608.

10.

Decousus

Leizorovicz

Parent

, 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(7):409–415.

11.

Mismetti

Laporte

Pellerin

, et al. Effect of a retrievable inferior vena cava filter plus anticoagulation vs anticoagulation alone on risk of recurrent pulmonary embolism: a randomized clinical trial. JAMA. 2015;313(16):1627–1635.

12.

PREPIC Study Group. Eight-year follow-up of patients with permanent vena cava filters in the prevention of pulmonary embolism. Circulation. 2005;112(3):416–422.

13.

Kucher

Rossi

De Rosa

, et al. Massive pulmonary embolism. Circulation. 2006;113(4):577–582.

14.

Barginear

Gralla

Bradley

, et al. Investigating the benefit of adding a vena cava filter to anticoagulation with fondaparinux sodium in patients with cancer and venous thromboembolism in a prospective randomized clinical trial. Support Care Cancer. 2012;20(11):2865–2872.

15.

Bikdeli

Chatterjee

Desai

, et al. Inferior vena cava filters to prevent pulmonary embolism: systematic review and meta-analysis. J Am Coll Cardiol. 2017;70(13):1587–1597.

16.

Weinberg

Abtahian

DeBiasi

, et al. Effect of delayed inferior vena cava filter retrieval after early initiation of anticoagulation. Am J Cardiol. 2014;113(2):389–394.

17.

Grewal

Chamarthy

Kalva

SP.

Complications of inferior vena cava filters. Cardiovasc Diagn Ther. 2016;6(6):632–641.

18.

Mismetti

Rivron-Guillot

Quenet

, et al. A prospective long-term study of 220 patients with a retrievable vena cava filter for secondary prevention of venous thromboembolism. Chest. 2007;131(1):223–229.

19.

Stein

Kayali

Olson

RE.

Twenty-one-year trends in the use of inferior vena cava filters. Arch Intern Med. 2004;164(14):1541–1545.

20.

Baadh

Zikria

Rivoli

, et al. Indications for inferior vena cava filter placement: do physicians comply with guidelines? J Vasc Interv Radiol. 2012;23(8):989–995.

21.

Patel

Panikkath

Fenire

, et al. Indications and appropriateness of inferior Vena cava Filter placement. Am J Med Sci. 2015;349(3):212–216.

22.

Sader

Friedman

Berkowitz

, et al. Inferior vena cava filters and their varying compliance with the ACCP and the SIR guidelines. South Med J. 2014;107(9):585–590.

23.

Spencer

Bates

Goldberg

, et al. A population-based study of inferior vena cava filters in patients with acute venous thromboembolism. Arch Intern Med. 2010;170(16):1456–1462.

24.

White

Geraghty

Brunson

, et al. High variation between hospitals in vena cava filter use for venous thromboembolism. JAMA Intern Med. 2013;173(7):506–512.

25.

Swami

Annunziata

Fulger

Experience with vena cava filters at a large community hospital and level I trauma center: indications, complications, and compliance barriers. Clin Appl Thromb Hemost. 2014;20(5):546–552.

26.

Harris

Taylor

Thielke

, et al. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–381.

27.

Harris

Taylor

Minor

, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208.

28.

Sharifi

Bay

Skrocki

, et al. Role of IVC filters in endovenous therapy for deep venous thrombosis: the FILTER-PEVI (filter implantation to lower thromboembolic risk in percutaneous endovenous intervention) trial. Cardiovasc Intervent Radiol. 2012;35(6):1408–1413.

29.

Baldridge

Martin

Welling

RE.

Clinical significance of free-floating venous thrombi. J Vasc Surg. 1990;11(1):62–7. Discussion 68–69.

30.

Norris

Greenfield

Herrmann

JB.

Free-floating iliofemoral thrombus. Arch Surg. 1985;120(7):806–808.

31.

Pacouret

Alison

Pottier

, et al. Free-floating thrombus and embolic risk in patients with angiographically confirmed proximal deep venous thrombosis: a prospective study. Arch Intern Med. 1997;157(3):305–308.

32.

US Food and Drug Administration. Removing retrievable inferior vena cava filters: initial communication. Published 2010. Accessed August 6, 2023. https://wayback.archive-it.org/7993/20161022180008/http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm221676.htm

33.

US Food and Drug Administration. Removing retrievable inferior vena cava filters: FDA safety communication. Published 2014. Accessed August 6, 2023. https://wayback.archive-it.org/7993/20161022044053/http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm396377.htm

34.

Dawson

DL.

PRESERVE trial confirms low risk for most inferior vena cava filters, but benefit remains uncertain. J Vasc Surg Venous Lymphat Disord. 2023;11(3):586.

35.

Johnson

Spies

Scott

, et al. Predicting the safety and effectiveness of inferior vena cava filters (PRESERVE): outcomes at 12 months. J Vasc Surg Venous Lymph Disord. 2023;11(3):573–585. e6.

36.

Young

Sriram

KB.

Vena caval filters for the prevention of pulmonary embolism. Cochrane Database Syst Rev. 2020;10(10):CD006212.

37.

Reddy

Lakhter

Zack

, et al. Association between contemporary trends in inferior vena cava filter placement and the 2010 US Food and Drug Administration advisory. JAMA Intern Med. 2017;177(9):1373–1374.

38.

Wang

Lloyd

AJ.

Clinical review: inferior vena cava filters in the age of patient-centered outcomes. Ann Med. 2013;45(7):474–481.

39.

Redberg

RF.

Continued high rates of IVC filter use after US food and drug safety warning. JAMA Intern Med. 2017;177(9):1374–1375.

40.

Carroll

Beyer

Mehegan

, et al. Changes in care for acute pulmonary embolism through a multidisciplinary pulmonary embolism response team. Am J Med. 2020;133(11):1313–1321.

41.

Wang

Cha

Lin

, et al. Impact of physician education and a dedicated inferior vena cava Filter tracking system on inferior vena cava filter use and retrieval rates across a Large US health care region. J Vasc Interv Radiol. 2016;27(5):740–748.

42.

Uberoi

Tapping

Chalmers

, et al. British Society of Interventional Radiology (BSIR) inferior Vena cava (IVC) filter registry. Cardiovasc Intervent Radiol. 2013;36(6):1548–1561.

43.

Winters

Morris

Holmes

, et al. A multidisciplinary quality improvement program increases the inferior vena cava filter retrieval rate. Vasc Med. 2017;22(1):51–56.

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