Indications, Complications, and Management of Inferior Vena Cava Filters
Indications, Complications, and Management of Inferior Vena Cava Filters
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DOI：
10.1001/jamainternmed.2013.343
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发表时间：
2013-04-08
影响因子：
39
通讯作者：
Sloan, J. Mark
中科院分区：
文献类型：
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作者：
Sarosiek, Shayna;Crowther, Mark;Sloan, J. Mark
重要性：可回收下腔静脉（IVC）滤器旨在提供临时保护，防止肺栓塞，使患者免于永久性滤器的长期并发症。然而，许多可回收的下腔静脉滤器被无限期地留在原位。目的：回顾下腔静脉滤器患者的病历，以确定患者的人口统计学资料、下腔静脉滤器放置的日期和适应症，以及并发症、随访数据、下腔静脉滤器回收日期和抗凝治疗的使用。设计和设置：2003年8月1日至2011年2月28日期间，在波士顿医疗中心（新英格兰最大的创伤中心的三级转诊中心）对下腔静脉滤器的使用进行了回顾性分析。26例患者被排除在研究之外，因为不完整的医疗records.Intervention：放置可回收的IVC过滤器。主要结果测量：在总数中，952个医疗记录被包括在analys.Results中：679个可回收的IVC过滤器被放置，58（8.5%）被成功地删除。13例患者（18.3%的尝试）尝试回收失败。74例静脉血栓形成事件（研究纳入的952例患者的7.8%）发生在IVC滤器置入后，包括25例肺栓塞，所有这些事件均发生在IVC滤器就位时。48%的静脉血栓形成事件发生在放置IVC滤器时未发生静脉血栓栓塞的患者中，89.4%发生在未接受抗凝剂的患者中。许多在创伤后放置的IVC滤器在最高出血风险消退时插入，抗凝治疗可能是适当的。虽然许多滤器的放置是因为抗凝剂禁忌症，但237例患者（24.9%）出院后接受抗凝治疗。结论和相关性：我们的研究表明，使用IVC过滤器预防和治疗静脉血栓事件，结合低回收率和不一致的抗凝治疗，由于静脉血栓栓塞的高发生率而导致次优结果。
Importance: Retrievable inferior vena cava (IVC) filters were designed to provide temporary protection from pulmonary embolism, sparing patients from long-term complications of permanent filters. However, many retrievable IVC filters are left in place indefinitely.Objectives: To review the medical records of patients with IVC filters to determine patient demographics and date of and indication for IVC filter placement, as well as complications, follow-up data, date of IVC filter retrieval, and use of anticoagulant therapy.Design and Setting: A retrospective review of IVC filter use between August 1, 2003, and February 28, 2011, was conducted at Boston Medical Center, a tertiary referral center with the largest trauma center in New England.Participants: In total, 978 patients. Twenty six patients were excluded from the study because of incomplete medical records.Intervention: Placement of retrievable IVC filter.Main Outcome Measures: In total, 952 medical records were included in the analysis.Results: Of 679 retrievable IVC filters that were placed, 58 (8.5%) were successfully removed. Unsuccessful retrieval attempts were made in 13 patients (18.3% of attempts). Seventy-four venous thrombotic events (7.8% of 952 patients included in the study) occurred after IVC filter placement, including 25 pulmonary emboli, all of which occurred with the IVC filter in place. Forty-eight percent of venous thrombotic events were in patients without venous thromboembolism at the time of IVC filter placement, and 89.4% occurred in patients not receiving anticoagulants. Many IVC filters placed after trauma were inserted when the highest bleeding risk had subsided, and anticoagulant therapy may have been appropriate. While many of these filters were placed because of a perceived contraindication to anticoagulants, 237 patients (24.9%) were discharged on a regimen of anticoagulant therapy.Conclusion and Relevance: Our research suggests that the use of IVC filters for prophylaxis and treatment of venous thrombotic events, combined with a low retrieval rate and inconsistent use of anticoagulant therapy, results in suboptimal outcomes due to high rates of venous thromboembolism.