A Measured Approach to Vena Cava Filter Use—Respect Rather Than Regret

Jaff, Michael R.; Kaufman, John A.

doi:10.1001/jamacardio.2016.3882

Cited by 3 publications

(1 citation statement)

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“…As is true for many treatments that were later shown to be harmful and have been abandoned, such as antiarrhythmic medications for patients following myocardial infarction, or metal-on-metal hips, some argue that it is impossible to do a randomized clinical trial of IVC filters because practice patterns are set . As is true for many invasive treatments, IVC filter use is much higher in the United States than any other country.…”

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Continued High Rates of IVC Filter Use After US Food and Drug Safety Warning

Redberg

2017

JAMA Intern Med

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for this procedure by the way of bundling the associated Current Procedural Terminology (CPT) codes. 4 However, we observed a decline in IVCF use starting in 2010, which was 2 years prior to bundling of IVCF-related CPT codes. It is likely, however, that the reduction in IVCF reimbursement will have an added effect in further reducing the IVCF use across the United States. Another notable variable that changed during course of the study period was introduction of novel oral anticoagulant (NOAC) medications for prevention and treatment of VTE. However, the impact of NOAC use on utilization of IVCFs in the United States is not clear at this time.Prior studies have reported on the impact of various FDA advisories on clinical practice. Kim et al 5 found a 71% reduction in the use of gadolinium-enhanced magnetic resonance studies among patients with chronic kidney disease in the 2 years following the 2006 FDA advisory describing the risk of nephrogenic systemic sclerosis. Similarly, a 24% reduction in the use of antidepressant medications was seen in young adults following the 2003 FDA advisory regarding increased risk of suicide with these medications among young patients. 6 Despite the significant reduction in IVCF use following the FDA advisory, implantation rates across the United States remain high. Given the short-and long-term complications associated with IVCF placement, the use of these devices should be mostly reserved for those patients with an absolute indication like active bleeding. Because the rate of IVCF implantation in 5 large European countries is less than 3 per 100 000 population, we believe that the appropriate implantation rate in the United States should be similar to or lower than the rate observed in Europe. 1

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