Friday, February 21, 2014

We're defeating the purpose of retrievable IVC filters

What a horrible job we're doing:

The aim of this study was to determine patient characteristics, indications for IVCF placement, retrieval rates, complications, and post-IVCF anticoagulation (AC) practices in patients who have received IVCFs. A retrospective review of IVCF use by 3 specialty groups from January 1, 2009, to December 31, 2011, was conducted at a tertiary referral center...Indications for IVCF placement included contraindication to AC in the presence of acute venous thromboembolism (n = 287 [41.7%]) and prophylaxis (n = 235 [34.2%]). Insertion-related complications occurred in 28 patients (4.1%). After IVCF placement, adequate AC was initiated in 454 patients (66.0%) less than 3.0 days (interquartile range 0 to 13.0) after insertion, but the overall retrieval rate was only 252 of 688 (36.6%)...many patients have IVCF-related complications, and often, even when IVCFs are retrieved, there is a delay between AC and retrieval. Quality improvement initiatives that facilitate the expeditious retrieval of IVCF are needed.

This isn't the first time I've been made aware that removal rates for retrievable filters are low. It's almost funny that we would have to consider a “systems” initiative for something so simple and so obvious. How can the hospitalist help? In consulting someone to insert an IVC filter discuss the indications for a retrievable versus a permanent filter. If a retrievable one is used discuss the plans for removal, early. Inform the patient. Be explicit about it in the medical record.

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