Section of Hematology and Oncology, Department of Medicine, Boston University, Boston, MA 02118, USA.
JAMA Intern Med. 2013 Apr 8;173(7):513-7. doi: 10.1001/jamainternmed.2013.343.
Retrievable inferior vena cava (IVC) filters were designed to provide temporary protection from pulmonary embolism, sparing patients from long-term complications of permanent filters. However, many retrievable IVC filters are left in place indefinitely.
To review the medical records of patients with IVC filters to determine patient demographics and date of and indication for IVC filter placement, as well as complications, follow-up data, date of IVC filter retrieval, and use of anticoagulant therapy.
A retrospective review of IVC filter use between August 1, 2003, and February 28, 2011, was conducted at Boston Medical Center, a tertiary referral center with the largest trauma center in New England.
In total, 978 patients. Twenty six patients were excluded from the study because of incomplete medical records.
Placement of retrievable IVC filter.
In total, 952 medical records were included in the analysis.
Of 679 retrievable IVC filters that were placed, 58 (8.5%) were successfully removed. Unsuccessful retrieval attempts were made in 13 patients (18.3% of attempts). Seventy-four venous thrombotic events (7.8% of 952 patients included in the study) occurred after IVC filter placement, including 25 pulmonary emboli, all of which occurred with the IVC filter in place. Forty-eight percent of venous thrombotic events were in patients without venous thromboembolism at the time of IVC filter placement, and 89.4% occurred in patients not receiving anticoagulants. Many IVC filters placed after trauma were inserted when the highest bleeding risk had subsided, and anticoagulant therapy may have been appropriate. While many of these filters were placed because of a perceived contraindication to anticoagulants, 237 patients (24.9%) were discharged on a regimen of anticoagulant therapy.
Our research suggests that the use of IVC filters for prophylaxis and treatment of venous thrombotic events, combined with a low retrieval rate and inconsistent use of anticoagulant therapy, results in suboptimal outcomes due to high rates of venous thromboembolism.
可回收下腔静脉（IVC）滤器的设计目的是为了提供对肺栓塞的临时保护，使患者免受永久性滤器的长期并发症影响。然而，许多可回收的 IVC 滤器被无限期地留在原位。
回顾 IVC 滤器使用的病历，以确定患者的人口统计学特征以及 IVC 滤器放置的日期和适应证，以及并发症、随访数据、IVC 滤器取出的日期和抗凝治疗的使用情况。
2003 年 8 月 1 日至 2011 年 2 月 28 日，在波士顿医疗中心（一家拥有新英格兰最大创伤中心的三级转诊中心）对 IVC 滤器的使用情况进行了回顾性研究。
共有 978 名患者。由于病历不完整，26 名患者被排除在研究之外。
放置可回收 IVC 滤器。
共分析了 952 份病历。
在放置的 679 个可回收 IVC 滤器中，58 个（8.5%）被成功取出。在 13 名患者（尝试取出的 18.3%）中，未能成功取出。IVC 滤器放置后发生了 74 例静脉血栓事件（研究中纳入的 952 名患者的 7.8%），包括 25 例肺栓塞，所有这些事件均发生在 IVC 滤器在位时。48%的静脉血栓事件发生在 IVC 滤器放置时无静脉血栓栓塞的患者中，89.4%的患者未接受抗凝治疗。许多在创伤后放置的 IVC 滤器是在出血风险最高的情况下插入的，此时可能需要抗凝治疗。虽然许多滤器是因为存在抗凝治疗的禁忌症而放置的，但 237 名患者（24.9%）出院时接受了抗凝治疗方案。
我们的研究表明，由于静脉血栓栓塞事件的高发生率，IVC 滤器用于预防和治疗，加上低取出率和抗凝治疗的不一致使用，导致了不理想的结果。
