Wednesday, March 16, 2011

Guidelines for IVC filters differ

Hospitalist News reports on a poster presentation:

The current, published guidelines of the American College of Chest Physicians (ACCP) and the Society of Interventional Radiology (SIR) lack agreement on the indications for placement of inferior vena cava filters during routine practice. And the implications of the contradictory guidelines are growing because use of inferior vena cava filters has risen significantly in recent years, Dr. Amanjit S. Baadh and his associates said in a poster they presented at ISET 2011, an international symposium on endovascular therapy.

Actually there are three sets of guidelines, and the one they didn't mention, from the Thrombosis Interest Group of Canada, is the most strict of all. According to that guideline the only proven indication for an IVC filter is acute proximal DVT with an absolute contraindication to anticoagulants. The SIR guidelines are much more liberal, listing as “relative indications” (things the TIGC regards as controversial and not supported by evidence) such things as free floating thrombus, massive PE and various prophylactic uses.

The problems here are the dearth of high level evidence (forcing guideline authors to consider lower level evidence and rely on their expertise) and the obvious conflict of interest of the Society of Interventional Radiology.

No comments: