Shah Mahek, Alnabelsi Talal, Patil Shantanu, Reddy Shilpa, Patel Brijesh, Lu Marvin, Chandorkar Aditya, Perelas Apostholos, Arora Shilpkumar, Patel Nilay, Jacobs Larry, Eiger Glenn G
Department of Cardiology, Lehigh Valley Hospital, Allentown Department of Medicine Department of Radiology, Einstein Medical Center, Philadelphia, PA Mount Sinai St Luke's-Roosevelt Hospital, New York, NY Saint Peter's University Hospital, New Brunswick, NJ Division of Pulmonary and Critical Care, Einstein Medical Center, Philadelphia, PA.
Medicine (Baltimore). 2017 Mar;96(12):e6449. doi: 10.1097/MD.0000000000006449.
Inferior vena cava filter (IVCF) placement appears to be expanding over time despite absence of clear directing evidence.Two populations were studied. The first population included patients who received an IVCF between January 2005 and August 2013 at our community hospital center. Demographic information, indications for placement, and retrieval rate was recorded among other variables. The second population comprised of patients receiving an IVCF from 2005 to 2012 according to the Nationwide Inpatient Sample (NIS) using ICD-9CM coding. Patients were divided into 2 groups based on the year of admission for comparison, that is, first group from 2005 to 2008 and the second from 2009 to 2012. In addition, we analyzed annual trends in filter placement, acute venothromboembolic events (VTE) and several underlying comorbidities within this population.At our center, 802 IVCFs were placed (55.2% retrievable); 34% for absolute, 61% for relative, and 5% for prophylactic indications. Major bleeding (27.5%), minor self-limited bleeding (13.7%), and fall history (11.2%) were the commonest indications. Periprocedural complication rate was 0.7%, and filter retrieval rate was 7%. The NIS population (811,487 filters) saw a decline in IVCF placement after year 2009, following an initial uptrend (Ptrend < 0.01). IVCF use among patients with neither acute VTE nor bleeding among prior VTE saw a 3-fold absolute reduction from 2005 to 2012 (33,075-11,655; Ptrend < 0.01). Patients from 2009 to 2012 were more likely to be male and had higher rates of acute VTE, thrombolytic use, cancer, bleeding, hypotension, acute cardiorespiratory failure, shock, prior falls, blood product transfusion, hospital mortality including higher Charlson comorbidity scores. The patients were younger, had shorter length of stay, and were less likely to be associated with strokes including hemorrhagic or require ventilator support. Prior falls (adjusted odds ratio-aOR 2.8), thrombolytic use (aOR 1.76), and shock (aOR 1.45) were most predictive of IVCF placement between 2009 and 2012 on regression analysis.Recent trends suggest that a higher proportion of patients receive temporary IVCF, for predominantly relative indications. Nationally, the number of filters being placed is decreasing, especially among those who did not experience acute VTE or bleeding events. Prior falls, thrombolytic therapy, and shock were most predictive of IVCF placement in latter half of the study period.
尽管缺乏明确的指导性证据，但随着时间的推移，下腔静脉滤器（IVCF）的植入似乎仍在增加。我们研究了两个人群。第一人群包括2005年1月至2013年8月在我们社区医院中心接受IVCF植入的患者。记录了人口统计学信息、植入指征和取出率等变量。第二人群由2005年至2012年根据全国住院患者样本（NIS）使用ICD-9CM编码接受IVCF植入的患者组成。根据入院年份将患者分为两组进行比较，即2005年至2008年的第一组和2009年至2012年的第二组。此外，我们分析了该人群中滤器植入、急性静脉血栓栓塞事件（VTE）和几种潜在合并症的年度趋势。在我们中心，共植入了802个IVCF（55.2%为可取出型）；绝对指征占34%，相对指征占61%，预防性指征占5%。主要出血（27.5%）、轻度自限性出血（13.7%）和跌倒史（11.2%）是最常见的指征。围手术期并发症发生率为0.7%，滤器取出率为7%。NIS人群（811487个滤器）在2009年后IVCF植入量呈下降趋势，此前呈上升趋势（Ptrend＜0.01）。2005年至2012年，既往无急性VTE或出血的患者中IVCF的使用绝对减少了3倍（从33075降至11655；Ptrend＜0.01）。2009年至2012年的患者更可能为男性，急性VTE、溶栓治疗、癌症、出血、低血压、急性心肺衰竭、休克、既往跌倒、输血、医院死亡率包括较高的Charlson合并症评分的发生率更高。这些患者更年轻，住院时间更短，与包括出血性中风在内的中风相关的可能性更小，或不需要呼吸机支持。回归分析显示，既往跌倒（调整比值比-aOR 2.8）、溶栓治疗（aOR 1.76）和休克（aOR 1.45）是2009年至2012年IVCF植入的最强预测因素。近期趋势表明，越来越多的患者接受临时IVCF植入，主要是出于相对指征。在全国范围内，滤器植入数量正在减少，尤其是在那些没有经历急性VTE或出血事件的患者中。既往跌倒、溶栓治疗和休克是研究后半期IVCF植入的最强预测因素。
