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Evidence Base for Vena Cava Filter Use 'Thin'

Cheryl Clark, for HealthLeaders Media, April 11, 2013

"These IVC filters as they're currently used don't really work as well as physicians think they do," says Sloan. "Though there has been a general acknowledgement that the filters may have short-term benefits and long term complications, so with the advent of temporary filters, they'd get the best of both world. But the reality is that a temporary filter is only temporary if it is actually removed. And it typically isn't."

Extremely frustrating, he adds, is that professional societies, guideline statements, hospitals, and different departments within hospitals aren't consistent, and disagree over which patients are appropriate to receive these filters. "They'll say, for example, 'this patient can not receive anticoagulation medications, and that's why I'm putting in this filter, and then proceed to give anticoagulants to that person almost immediately afterwards."

Of the 679 retrievable IVC filters placed, only 8.5% were removed, and unsuccessful attempts were made for another 18.3%, they reported.

While this paper tracked patients at BMC over nearly a decade, Sloan says, "the findings "are not by any means unique to our institution. It's in keeping with what most major medical centers would report if they were to track this data."

The BMC research is published in the April 8 JAMA Internal Medicine, an issue that includes a second IVC report from the University of California Davis showing more risk adjusted variation in the use of these IVC filters throughout hospitals in the state than for any other procedure.

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