Original Article

Inferior Vena Cava Filters and Their Varying Compliance with the ACCP and the SIR Guidelines

Authors: Roula Bou Sader, MD, Adie Friedman, MD, Eric Berkowitz, MD, Eric Martin, DM (Oxon)

Abstract

Objectives: We examined our experience with inferior vena cava filters to assess whether we conformed to the American College of Chest Physicians (ACCP) and the Society of Interventional Radiology (SIR) guidelines and to evaluate the reasons for any discrepancy.

Methods: This was a retrospective medical record review of patients having inferior vena cava filters placed in two New York City hospitals during a 34-month period. The indications for filter placement, the type of filter used, and the conformity with the two guidelines were noted.

Results: A total of 345 filters were placed; 41.4% were permanent and 58.6% were optional. Compliance with SIR guidelines was 95.7% and 41.3% with ACCP guidelines. A total of 173 patients (50.4%) did not conform to the ACCP guidelines while meeting the SIR guidelines. Seventy-one of these patients had a documented venous thromboembolism in the perioperative period, 24 experienced recurrent or progressive venous thromboembolism while on anticoagulation, and 24 were judged to have advanced cardiopulmonary disease. Thirty patients had prophylactic filters, the majority of whom were in the perioperative period. These conditions were the main causes of discrepancy between the guidelines.

Conclusions: Compliance with the ACCP guidelines is poor in this series; however, much of the discrepancy is based on grade 2C evidence. Only grade 1 evidence will reconcile the differences between the two guidelines.

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References

1. Baadh AS, Zikria JF, Rivoli S, et al. Indications for inferior vena cava filter placement: do physicians comply with guidelines? J Vasc Interv Radiol 2012;23:989-995.
 
2. ACCP-NHLBI National Conference on Antithrombotic Therapy. American College of Chest Physicians and the National Heart, Lung and Blood Institute. Chest 1986;89(2 Suppl):1S-106S.
 
3. Hirsh J, Guyatt G, Albers GW, et al. Executive summary: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008;133:71S-109S.
 
4. Guyatt GH, Akl EA, Crowther M, et al. Executive summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141(2 Suppl):7S-47S.
 
5. Kaufman JA, Kinney TB, Streiff MB, et al. Guidelines for the use of retrievable and convertible vena cava filters: report from the Society of Interventional Radiology multidisciplinary consensus conference. J Vasc Interv Radiol 2006;17:449-459.
 
6. Caplin DM, Nikolic B, Kalva SP, et al. Quality improvement guidelines for the performance of inferior vena cava filter placement for the prevention of pulmonary embolism. J Vasc Interv Radiol 2011;22:1499-1506.
 
7. Kearon C, Akl EA, Comerota AJ, et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141(2 Suppl):e419S-e94S.
 
8. Douketis JD, Spyropoulos AC, Spencer FA, et al. Perioperative management of antithrombotic therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141(2 Suppl):e326S-e50S.
 
9. Büller HR, Agnelli G, Hull RD, et al. Antithrombotic therapy for venous thromboembolic disease: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004;126(3 Suppl):401S-428S.
 
10. MacLean S, Mulla S, Akl EA, et al. Patient values and preferences in decision making for antithrombotic therapy: a systematic review: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141(2 Suppl):e1S-e23S.
 
11. Spencer FA, Bates SM, Goldberg RJ, et al. A population-based study of inferior vena cava filters in patients with acute venous thromboembolism. Arch Intern Med 2010;170:1456-1462.
 
12. Duszak R Jr, Parker L, Levin DC, Rao VM. Placement and removal of inferior vena cava filters : national trends in the medicare population. J Am Coll Radiol 2011;8:483-489.
 
13. Global inferior vena cava (IVC) filters-market growth analysis, 2009-2015 market. http://www.bloomberg.com/article/2013-10-30/afdB.9llymLQ.html. Published October 30, 2013. Accessed August 1, 2014.
 
14. US Food and Drug Administration. Removing retrievable inferior vena cava filters: initial communication. Available at http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm221676.htm. Published August 9, 2010. Accessed November 26, 2013.
 
15. Stein PD, Matta F, Hull RD. Increasing use of vena cava filters for prevention of pulmonary embolism. Am J Med 2011;124:655-661.
 
16. Smouse B, Johar A. Is market growth of vena cava filters justified? A review of indications, use, and market analysis. http://evtoday.com/2010/02/is-market-growth-of-vena-cava-filters-justified. Published February 2010. Accessed August 1, 2014.
 
17. Silverstein MD, Heit JA, Mohr DN, et al. Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch Int Med 1998;158:585-593.
 
18. Smouse HB, Mendes R, Bosiers M, et al. The RETRIEVE trial: safety and effectiveness of the retrievable crux vena cava filter. J Vasc Interv Radiol 2013;24:609-621.
 
19. Eifler AC, Lewandowski RJ, Gupta R, et al. Optional or permanent: clinical factors that optimize inferior vena cava filter utilization. J Vasc Interv Radiol 2013;24:35-40.
 
20. Minocha J, Idakoji I, Riaz A, et al. Improving inferior vena cava filter retrieval rates: impact of a dedicated inferior vena cava filter clinic. J Vasc Interv Radiol 2010;21:1847-1851.
 
21. Lynch FC. A method for following patients with retrievable inferior vena cava filters: results and lessons learned from the first 1,100 patients. J Vasc Interv Radiol 2011;22:1507-1512.
 
22. Maddali S, Biring T, Bluhm J, et al. Antithrombotic Therapy Supplement, 11th ed. Bloomington, MN: Institute for Clinical Systems Improvement; 2013.