A Medicare study has found that the use of inferior vena cava filter (IVC filter) for the prevention of pulmonary embolism (PE) increased somewhat between 1999 and 2010, despite questions regarding clinical benefit.
During that period of time, as PE-related hospitalizations rose, so did the proportions of those admitted that were placed with IVC filters. However, the frequency of PE hospitalizations with filter placement did not increase significantly over the same period among all PE patients.
The study focused on the experiences of 556,658 Medicare beneficiaries over age 65 who were hospitalized with PE. Certain subgroups saw bigger changes in inferior vena cava filter insertion, including patients over age 85, who had the largest increase in filter placement in 2010, while black participants had the largest drop. The study authors concluded that mortality associated with PE hospitalizations is generally on the decline, regardless of IVC filter use.
The study also found that the filters are most often used in patients that are not shown to benefit from their use. According to the researchers, “the vast majority of inferior vena caval filters (91 percent) are inserted in patients with PE in stable condition, and such patients have not been shown to receive a clinically meaningful benefit.” Conversely, only 27 percent of those who might benefit – those in unstable condition – actually receive the filters.
What are IVC Filters?
IVC filters are used to prevent PE, a potentially preventable cause of death in hospitalized and other high-risk patients. The probability of PE increases with the development of deep vein thrombosis (DVT), and the treatment for both PE and DVT is anticoagulation, but in circumstances when blood thinners are not appropriate, an IVC filter is used instead.