Stevens Hannah, Bortz Hadley, Chao Sharon, Ramanan Radha, Clements Warren, Peter Karlheinz, McFadyen James D, Tran Huyen
Department of Haematology, Alfred Hospital, Melbourne, Victoria, Australia.
Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia.
Res Pract Thromb Haemost. 2023 Jan 7;7(1):100040. doi: 10.1016/j.rpth.2023.100040. eCollection 2023 Jan.
The placement of retrievable inferior vena cava (IVC) filters occurs commonly, but retrieval rates remain low. Consequently, there is an unmet clinical need to ensure appropriate follow-up and retrieval of these devices.
To determine the association between an IVC filter surveillance team with filter retrievals or a documented filter plan, time to retrieval, and incidence of filter complications or recurrent venous thromboembolism.
Ambidirectional cohort study evaluating consecutive IVC filter insertions before and after the implementation of a multidisciplinary surveillance team (MDST). We report an odds ratio (OR) with 95% CIs, adjusted by age, sex, weight, and malignancy status.
Overall, 453 patients were included, with 272 individuals in the pre-MDST cohort and 181 individuals in the post-MDST cohort. The MDST was associated with a higher composite primary outcome of IVC filter retrieval or a documented filter plan from 79.4% in the pre-MDST cohort to 96.1% in the post-MDST cohort (OR, 6.44; 95% CI, 3.06-15.84) Compared with the pre-MDST cohort, IVC filter retrieval rates were higher in the post-MDST cohort (52.6%-73.5%, respectively; (OR, 2.50; 95% CI, 1.67-3.78). The MDST was associated with a shorter median time-to-filter retrieval (187-150 days, hazard ratio, 1.78; 95% CI, 1.39-2.29), but there was no significant difference when comparing symptomatic or clinically significant IVC filter complications, recurrent venous thromboembolism, or mortality.
Our study demonstrates the importance of a structured program to ensure timely IVC filter retrieval and ultimately improve patient care.
可回收下腔静脉（IVC）滤器的植入很常见，但取出率仍然很低。因此，在确保对这些装置进行适当的随访和取出方面，临床需求尚未得到满足。
确定IVC滤器监测团队与滤器取出或记录在案的滤器计划、取出时间以及滤器并发症或复发性静脉血栓栓塞发生率之间的关联。
双向队列研究，评估多学科监测团队（MDST）实施前后连续的IVC滤器植入情况。我们报告经年龄、性别、体重和恶性肿瘤状态调整后的比值比（OR）及95%置信区间（CI）。
总体纳入453例患者，MDST实施前队列中有272例，MDST实施后队列中有181例。MDST与IVC滤器取出或记录在案的滤器计划这一综合主要结局的发生率较高相关，从MDST实施前队列的79.4%升至MDST实施后队列的96.1%（OR为6.44；95%CI为3.06 - 15.84）。与MDST实施前队列相比，MDST实施后队列的IVC滤器取出率更高（分别为52.6% - 73.5%；OR为2.50；95%CI为1.67 - 3.78）。MDST与滤器取出的中位时间较短相关（187天 - 150天，风险比为1.78；95%CI为1.39 - 2.29），但在比较有症状或具有临床意义的IVC滤器并发症、复发性静脉血栓栓塞或死亡率时，差异无统计学意义。
我们的研究证明了一个结构化项目对于确保及时取出IVC滤器并最终改善患者护理的重要性。
