Ferro Enrico G, Mackel Julie B, Kramer Renee D, Torguson Rebecca, Whatley Eleni M, O'Connell Gregory, Pullin Brian, Watson Nathan W, Li Siling, Song Yang, Krawisz Anna K, Carroll Brett J, Schermerhorn Marc L, Weinstein Jeffrey L, Farb Andrew, Zuckerman Bram, Yeh Robert W, Secemsky Eric A
Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
JAMA. 2024 Dec 24;332(24):2091-2100. doi: 10.1001/jama.2024.19553.
Inferior vena cava filters (IVCFs) are commonly used to prevent pulmonary embolism in selected clinical scenarios, despite limited evidence to support their use. Current recommendations from professional societies and the US Food and Drug Administration endorse timely IVCF retrieval when clinically feasible. Current IVCF treatment patterns and outcomes remain poorly described.
To evaluate temporal trends and practice patterns in IVCF insertion and retrieval among older US patients and report the incidence of periprocedural and long-term safety events of indwelling and retrieved IVCFs.
DESIGN, SETTING, AND PARTICIPANTS: Prespecified, retrospective, observational cohort of Medicare Fee-for-Service (FFS) beneficiaries, leveraging 100% of samples of inpatient and outpatient claims data from January 1, 2013, to December 31, 2021.
First-time IVCF insertion while insured by Medicare FFS.
The primary safety outcome was the composite of all-cause death, filter-related complications (eg, fracture, embolization), operating room visits following filter-related procedures, or new diagnosis of deep vein thrombosis (DVT). Events were considered periprocedural if they occurred within 30 days of IVCF insertion or retrieval and long-term if they occurred more than 30 days after.
Among 270 866 patients with IVCFs placed during the study period (mean age, 75.1 years; 52.8% female), 64.9% were inserted for first-time venous thromboembolism (VTE), 26.3% for recurrent VTE, and 8.8% for VTE prophylaxis. Of these patients, 63.3% had major bleeds or trauma within 30 days of IVCF insertion. The volume of insertions decreased from 44 680 per year in 2013 to 19 501 per year in 2021. The cumulative incidence of retrieval was 15.3% at a median of 1.2 years and 16.8% at maximum follow-up of 9.0 years. Older age, more comorbidities, and Black race were associated with a decreased likelihood of retrieval, whereas placement at a large teaching hospital was associated with an increased likelihood of retrieval. The incidence of caval thrombosis and DVT among patients with nonretrieved IVCFs was 2.2% (95% CI, 2.1%-2.3%) and 9.2% (95% CI, 9.0%-9.3%), respectively. The majority (93.5%) of retrieval attempts were successful, with low incidence of 30-day complications (mortality, 0.7% [95% CI, 0.6%-0.8%]; filter-related complications, 1.4% [95% CI, 1.2%-1.5%]).
In this large, US real-world analysis, IVCF insertion declined, yet retrievals remained low. Strategies to increase timely retrieval are needed, as nonretrieved IVCFs may have long-term complications.
下腔静脉滤器（IVCFs）常用于特定临床场景中预防肺栓塞，尽管支持其使用的证据有限。专业协会和美国食品药品监督管理局的当前建议支持在临床可行时及时取出IVCF。目前IVCF的治疗模式和结果仍描述不足。
评估美国老年患者中IVCF植入和取出的时间趋势及实践模式，并报告留置和取出IVCF的围手术期及长期安全事件的发生率。
设计、设置和参与者：预先设定的、回顾性的、观察性队列研究，研究对象为医疗保险按服务付费（FFS）受益人，利用2013年1月1日至2021年12月31日住院和门诊索赔数据的100%样本。
首次在医疗保险FFS参保期间植入IVCF。
主要安全结局是全因死亡、滤器相关并发症（如骨折、栓塞）、滤器相关手术后的手术室就诊或新诊断的深静脉血栓形成（DVT）的综合情况。如果事件发生在IVCF植入或取出后30天内，则视为围手术期事件；如果发生在30天后，则视为长期事件。
在研究期间植入IVCF的270866例患者中（平均年龄75.1岁；52.8%为女性），64.9%因首次静脉血栓栓塞（VTE）植入，26.3%因复发性VTE植入，8.8%因VTE预防植入。在这些患者中，63.3%在IVCF植入后30天内发生了大出血或创伤。植入量从2013年的每年44680例降至2021年的每年19501例。取出的累积发生率在中位时间1.2年时为15.3%，在最长随访9.0年时为16.8%。年龄较大、合并症较多和黑人种族与取出可能性降低相关，而在大型教学医院植入则与取出可能性增加相关。未取出IVCF的患者中，腔静脉血栓形成和DVT的发生率分别为2.2%（95%CI，2.1%-2.3%）和9.2%（95%CI，9.0%-9.3%）。大多数（93.5%）取出尝试成功，30天并发症发生率较低（死亡率，0.7%[95%CI，0.6%-0.8%]；滤器相关并发症，1.4%[95%CI，1.2%-1.5%]）。
在这项大型美国真实世界分析中，IVCF植入量下降，但取出率仍然较低。由于未取出的IVCF可能有长期并发症，因此需要采取策略以增加及时取出率。
