Choe June, Liang Richard, Weinberg Aaron S, Tapson Victor F
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
School of Medicine, Stanford University, Stanford, CA, USA.
J Endovasc Ther. 2025 Aug;32(4):1109-1118. doi: 10.1177/15266028231204822. Epub 2023 Oct 26.
This study investigated physician compliance with indications for inferior vena cava (IVC) filter placement according to the 2012 American College of Chest Physicians (ACCP) and the 2011 Society of Interventional Radiology (SIR) guidelines.
A retrospective medical record review of 231 retrievable IVC filters placed between August 15, 2016, and December 28, 2017, at a large urban academic medical center. Guideline compliance to the 2012 ACCP and the 2011 SIR guidelines, and indications for IVC filter placements were assessed through an adjudication protocol. Filter retrieval and complication rates were also examined.
Compliance to guidelines was low (60.2% for ACCP; 74.0% for SIR), especially for non-intensive care unit (ICU) patients (ICU 74.6% vs non-ICU 54.8%, p=0.007 for ACCP; ICU 82.5% vs non-ICU 70.8%, p=0.092 for SIR). After adjudication, 8.2% (19/231) of filters were considered non-indicated but reasonable, 17.7% (41/231) non-indicated and unreasonable, and 13.9% (32/231) SIR-indicated but not ACCP-indicated. The most common indication was venous thromboembolism with contraindication to anticoagulation. The most common reasons for non-compliance were distal deep venous thrombosis with contraindication to anticoagulation (19/60, 31.6%) and clot burden (19/60, 31.6%). One-year filter retrieval and 90-day complication rates were 32.0% (74/231) and 6.1% (14/231), respectively.
Compliance to established guidelines was low. Reasons for non-compliance included limitations or discrepancies in guidelines, as well as non-evidence-based filter placements.Clinical ImpactDespite increasing utilization of inferior vena cava (IVC) filters, guideline compliance for IVC filter placement among providers is unclear. The results of this study indicate that physician compliance to established guidelines is poor, especially in non-intensive-care-unit patients. Noncompliance stems from non-evidence-based filter placement as well as differences and limitations in guidelines. Avoiding non-indicated IVC filter placement and consolidation of guidelines may significantly improve guideline compliance. The critical insights gained from this study can help promote judicious use of IVC filters and highlight the role of venous thromboembolism experts in navigating complex cases and nuances of guidelines.
本研究根据2012年美国胸科医师学会（ACCP）和2011年介入放射学会（SIR）指南，调查医生对下腔静脉（IVC）滤器置入指征的遵循情况。
对2016年8月15日至2017年12月28日期间在一家大型城市学术医疗中心置入的231个可回收IVC滤器进行回顾性病历审查。通过判定方案评估对2012年ACCP和2011年SIR指南的遵循情况以及IVC滤器置入的指征。还检查了滤器取出率和并发症发生率。
对指南的遵循率较低（ACCP为60.2%；SIR为74.0%），尤其是非重症监护病房（ICU）患者（ACCP：ICU为74.6%，非ICU为54.8%，p = 0.007；SIR：ICU为82.5%，非ICU为70.8%，p = 0.092）。判定后，8.2%（19/231）的滤器被认为无指征但合理，17.7%（41/231）无指征且不合理，13.9%（32/231）符合SIR指征但不符合ACCP指征。最常见的指征是静脉血栓栓塞且有抗凝禁忌。不遵循的最常见原因是远端深静脉血栓形成且有抗凝禁忌（19/60，31.6%）和血栓负荷（19/60，31.6%）。一年滤器取出率和90天并发症发生率分别为32.0%（74/231）和6.1%（14/231）。
对既定指南的遵循率较低。不遵循的原因包括指南中的局限性或差异，以及无循证依据的滤器置入。临床影响尽管下腔静脉（IVC）滤器的使用越来越多，但提供者对IVC滤器置入的指南遵循情况尚不清楚。本研究结果表明，医生对既定指南的遵循情况较差，尤其是在非重症监护病房患者中。不遵循源于无循证依据的滤器置入以及指南中的差异和局限性。避免无指征的IVC滤器置入和整合指南可能会显著提高指南遵循率。本研究获得的关键见解有助于促进IVC滤器的合理使用，并突出静脉血栓栓塞专家在处理复杂病例和指南细微差别方面的作用。
