title: Effect of delayed inferior vena cava filter retrieval after early initiation of anticoagulation.
abstract: Retrievable inferior vena cava filters (IVCFs) were designed to provide temporary protection from pulmonary embolism in high-risk situations. However, little is known about their effectiveness, and many remain permanently implanted, leading to potential complications. 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, procedural success and complications, post-IVCF AC practices, and patient outcomes were assessed. Seven hundred fifty-eight IVCFs were placed. Follow-up was available for 688 patients (90.7%) at a median of 342.0 days (interquartile range 81.5 to 758.0). 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%) <3.0 days (interquartile range 0 to 13.0) after insertion, but the overall retrieval rate was only 252 of 688 (36.6%) within a median of 134.0 days (interquartile range 72.50 to 205.8). Significant IVCF-related complications occurred in 122 patients (17.7%) within 32 days (interquartile range 13.0 to 116.8). The most common complication (72 of 131 [55.0%]) was deep vein thrombosis. In conclusion, in a large, modern cohort of patients receiving retrievable IVCFs for a variety of indications by various specialties, IVCF insertion remains safe. However, 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.
authors.affiliation: The Institute for Heart, Vascular and Stroke Care, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: iweinberg@partners.org.
authors.forename: Ido
authors.initials: I
authors.lastname: Weinberg
authors.affiliation: Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Farhad
authors.initials: F
authors.lastname: Abtahian
authors.affiliation: Medicine Department, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Ralph
authors.initials: R
authors.lastname: Debiasi
authors.affiliation: Medicine Department, Spaulding Rehabilitation Hospital, Boston, Massachusetts.
authors.forename: Philip
authors.initials: P
authors.lastname: Cefalo
authors.affiliation: The Institute for Heart, Vascular and Stroke Care, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Mackay
authors.affiliation: Cardiology Division, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
authors.forename: Beau M
authors.initials: BM
authors.lastname: Hawkins
authors.affiliation: The Institute for Heart, Vascular and Stroke Care, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Jaff
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use*; D020878:Device Removal / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D016306:Vena Cava Filters; D054556:Venous Thromboembolism / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology
chemical_list: D000925:Anticoagulants