Rottenstreich Amihai, Arad Ariela, Lev Cohain Naama, Bloom Allan I, Varon David, Klimov Alexander, Roth Batia, Kalish Yosef
Department of Hematology, Hadassah-Hebrew University Medical Center, POB 12000, 91120, Jerusalem, Israel.
Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
J Thromb Thrombolysis. 2017 Aug;44(2):190-196. doi: 10.1007/s11239-017-1513-1.
To evaluate the impact of an institutional protocol on patterns of use and outcomes of inferior vena cava filters (IVCF). Following a multidisciplinary effort, an institutional protocol involving dedicated follow-up of patients receiving IVCF and a physician education program regarding IVCF utilization, was established. We prospectively collected data of patients who received IVCF during 2015-2016, following protocol implementation (POST group). For comparison, we reviewed records of patients who received IVCF during 2009-2014, before implementation of the institutional protocol (PRE group). In the PRE and POST groups, 76 and 38 IVCF per year were inserted respectively, with an overall decrease of 50%. IVCF were more likely to be placed for therapeutic rather than prophylactic indications in the POST compared to the PRE group (P = 0.003). Follow-up rates at our coagulation clinic were significantly higher in the POST than the PRE group (100 vs. 22.9%, P < 0.0001), as were rates of attempted retrieval: 60.5% (23/38) vs. 16.7% (76/455), P < 0.0001. Failed retrieval occurred at similar rates: 15.8% (12/76) vs. 18.2% (4/22), P = 0.75. There was a trend towards a lower thrombotic complication rate in the POST than the PRE group: 2.6 vs. 11.2%, P = 0.16. Implementation of an institutional protocol significantly decreased the use of IVCF and increased the retrieval rate. Such intervention could potentially lead to lower rates of IVCF-related complications in the future.
评估一项机构规范对下腔静脉滤器（IVCF）使用模式及治疗结果的影响。经过多学科努力，制定了一项机构规范，其中包括对接受IVCF治疗的患者进行专门随访以及开展关于IVCF使用的医师教育项目。我们前瞻性收集了2015 - 2016年规范实施后接受IVCF治疗的患者数据（POST组）。为作比较，我们回顾了2009 - 2014年机构规范实施前接受IVCF治疗的患者记录（PRE组）。在PRE组和POST组中，每年分别植入76个和38个IVCF，总体减少了50%。与PRE组相比，POST组中IVCF更倾向于用于治疗而非预防指征（P = 0.003）。我们凝血门诊的随访率POST组显著高于PRE组（100%对22.9%，P < 0.0001），尝试取出率也是如此：60.5%（23/38）对16.7%（76/455），P < 0.0001。取出失败率相似：15.8%（12/76）对18.2%（4/22），P = 0.75。POST组血栓形成并发症发生率有低于PRE组的趋势：2.6%对11.2%，P = 0.16。实施机构规范显著减少了IVCF的使用并提高了取出率。这种干预可能会在未来降低IVCF相关并发症的发生率。
