Troubling results from the SAFE-IVC study revealed that just one in six patients gets their inferior vena cava filters removed, despite clear guidelines calling for IVC filter removal as early as possible.
- An IVC filter is a small device that helps stop blood clots from going up into the lungs and is usually surgically inserted.
- IVC filters are used to prevent pulmonary embolism in patients with venous thromboembolism and can’t receive anticoagulation treatment.
Out of SAFE-IVC’s roughly 270k Medicare beneficiaries, only 15% had their IVC filters retrieved within 1.2 years of insertion.
- That number barely rose to 16.8% at the study’s maximum follow up of nine years.
- Old age, comorbidities, and race decreased the likelihood of IVC retrieval, whereas placement at a large teaching hospital increased retrieval likelihood.
Patients who didn’t have their IVC filters removed had significant rates of filter-related complications (1.4%), caval thrombosis (2.2%), DVT hospital visits (9.2%), and new deep vein thrombosis (21.2%).
This IVC retrieval data directly contrasts FDA guidelines that call for removing IVC filters as soon as the patient’s PE risk subsides due to long-term complications such as filter fracture or device embolization.
- One potential reason for our low filter retrieval rates could be because the doctors placing IVC filters are often different from the physicians following these patients long-term.
Encouragingly, the number of annual IVC filter insertions across the study population decreased from 44,680 in 2013 to 19,501 in 2021.
- However, the U.S. still far surpasses the rest of the world in IVC filter insertions, with a staggering one in five older Americans receiving an IVC filter.
The Takeaway
The U.S. implants far more IVC filters than anywhere else, while post-operative follow-ups and removals are severely lacking, suggesting that our IVC filter situation is far from SAFE.
