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大型社区医院下腔静脉滤器的使用:一项回顾性队列研究。

Inferior vena cava filter use at a large community hospital: a retrospective cohort study.

作者信息

Fontyn Stephanie, Bai Yuxin, Bolger Samantha, Greco Kaity, Wang Tzu-Fei, Hamm Caroline, Cervi Andrea

机构信息

Schulich School of Medicine and Dentistry, London, ON, Canada.

Department of Medicine, University of Ottawa at The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, Canada.

出版信息

Sci Rep. 2024 May 3;14(1):10192. doi: 10.1038/s41598-024-60868-z.

Abstract

Inferior vena cava (IVC) filters are considered when patients with venous thromboembolism (VTE) develop a contraindication to anticoagulation. Use of IVC filters is increasing, despite associated complications and lack of data on efficacy in reducing VTE-related mortality. We characterized the pattern of IVC filter use at a large community hospital between 2018 and 2022. Specifically, we assessed the indications for IVC filter insertion, filter removal rates, and filter-associated complications. Indications for IVC filters were compared to those outlined by current clinical practice guidelines. We reviewed 120 consecutive filter placement events. The most common indications included recent VTE and active bleeding (40.0%) or need for anticoagulation interruption for surgery (25.8%). Approximately one-third (30.0%) of IVC filters were inserted for indications either not supported or addressed by guidelines. Half (50.0%) of patients had successful removal of their IVC filter. At least 13 patients (10.8%) experienced a filter-related complication. In a large community-based practice, nearly one-third of IVC filters were inserted for indications not universally supported by current practice guidelines. Moreover, most IVC filters were not removed, raising the risk of filter-associated complications, and supporting the need for development of comprehensive guidelines addressing use of IVC filters, and post-insertion monitoring practices.

摘要

当静脉血栓栓塞症(VTE)患者出现抗凝禁忌时,会考虑使用下腔静脉(IVC)滤器。尽管存在相关并发症且缺乏关于降低VTE相关死亡率疗效的数据,但IVC滤器的使用仍在增加。我们对一家大型社区医院在2018年至2022年期间IVC滤器的使用模式进行了描述。具体而言,我们评估了IVC滤器置入的指征、滤器取出率以及与滤器相关的并发症。将IVC滤器的指征与当前临床实践指南中概述的指征进行了比较。我们回顾了连续120例滤器置入事件。最常见的指征包括近期VTE和活动性出血(40.0%)或因手术需要中断抗凝(25.8%)。大约三分之一(30.0%)的IVC滤器置入指征未得到指南支持或未在指南中提及。一半(50.0%)的患者成功取出了IVC滤器。至少13例患者(10.8%)发生了与滤器相关的并发症。在一个大型社区实践中,近三分之一的IVC滤器置入指征未得到当前实践指南的普遍支持。此外,大多数IVC滤器未被取出,增加了与滤器相关并发症的风险,并支持制定关于IVC滤器使用及置入后监测实践的综合指南的必要性。

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