Evidence Base for Vena Cava Filter Use 'Thin'

Cheryl Clark, for HealthLeaders Media , April 11, 2013

There's "an exceptionally wide range in the frequency of VCF (vena cava filter) use between hospitals, from 0% to 38.96% of all acute VTE hospitalizations," wrote Richard H. White, MD, and colleagues of UC Davis School of Medicine. Variation was "even greater than the range observed for the surgical procedure (prostatectomy) that, in one study, had the highest variation across hospital referral regions in the United States."

His paper attributed the variation to "enthusiasm of specific physician-leaders within each hospital who advocate for or against the use of VCFs," and probably not "exploitation of the fiscal benefits," although hospitals receive about $16,200 more when a vena cava filter is placed under a higher acuity DRG code.

The problem is that failure to remove these filters can cause serious harm, as Sloan and colleagues documented in at least 10 patients who received them at BMC.

For example, nine filters that "had migrated from the initial location of placement and two filters that had fractured."

A 33-year old man in a motor vehicle crash had a prophylactic IVC filter placed despite no evidence he had a clot, but "the patient received no follow-up care at our institution for more than five years, until he returned with report of chest pain. He was found to have a fractured IVC filter, with one strut of the filter lodged in a pulmonary artery."

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