What is the clinical evidence from this study?

Study design: Cohort. Population: Venous thromboembolism risk (IVC filter placement) (n=9622). Intervention: Inferior vena cava (IVC) filter placement vs. Matched controls (no IVC filter). Primary outcome: Anticoagulant use at 3 months (prophylactic filter vs control) (OR 3.403, 95% CI 1.912-6.059, p=<0.001).

May 26, 2017Open Access

Retrospective analysis of outcomes following inferior vena cava (IVC) filter placement in a managed care population

Q: What are the key findings of this study?

IVC filter placement was associated with significantly increased odds of anticoagulant use at 3 months for both prophylactic (OR 3.403) and therapeutic (OR 1.356) indications compared to matched controls.

Key Result

IVC filter placement was associated with significantly increased odds of anticoagulant use at 3 months for both prophylactic (OR 3.403) and therapeutic (OR 1.356) indications compared to matched controls.

Study Design

Type

Cohort (n=9,622)

Structured PICO

Does inferior vena cava (IVC) filter placement improve clinical outcomes or reduce healthcare utilization compared to matched controls without filter placement?

Population

9,622 adults aged 22 to 89 years with commercial or Medicare Advantage coverage, including 4,811 who underwent prophylactic or therapeutic IVC filter placement and 4,811 matched controls, followed for up to 2.5 years.

Exposure

Inferior vena cava (IVC) filter placement (prophylactic or therapeutic)

Comparator

1:1 matched controls who did not undergo IVC filter placement (matched by age, gender, and surgery type or date of PE/DVT diagnosis)

Outcome

Post-index anticoagulant use, mortality, filter removal, device-related complications, and all-cause healthcare utilization (hospitalizations, readmissions, ED visits, physician office visits) at up to 2.5 yearssafety

In a managed care population, IVC filter placement was associated with increased anticoagulant use, higher healthcare utilization, and low retrieval rates, highlighting the need for more appropriate patient selection.

Main Result

Odds Ratio: 3.403 (95% CI 1.912–6.059)

Absolute Event Rate: 48.05% vs 20.92%

p-value: p=<0.001

Limitations

Baseline morbidity and bleeding risk were substantially greater in IVC filter treatment groups compared with control groups, allowing for potential residual confounding.
Inability to ascertain from claims data whether individuals met guidelines-supported criteria for filter placement.
Assessment of anticoagulant use following prophylactic filter placement may be biased because of less follow-up data for the filter group.
Codes used to identify device-related complications are not specific to IVC filters.
Errors in claims coding may have affected outcome measurement and the accuracy of regression models.
Results may not be generalizable to other managed care populations or a general U.S. population, and West/Northeast regions were underrepresented.

Abstract

The role of inferior vena cava filter (IVC) filters for prevention of pulmonary embolism (PE) is controversial. This study evaluated outcomes of IVC filter placement in a managed care population. This retrospective cohort study evaluated data for individuals with Humana healthcare coverage 2013-2014. The study population included 435 recipients of prophylactic IVC filters, 4376 recipients of therapeutic filters, and two control groups, each matched to filter recipients. Patients were followed for up to 2 years. Post-index anticoagulant use, mortality, filter removal, device-related complications, and all-cause utilization. Adjusted regression analyses showed a positive association between filter placement and anticoagulant use at 3 months: odds ratio (ORs) 3.403 (95% CI 1.912-6.059), prophylactic; OR, 1.356 (95% CI 1.164-1.58), therapeutic. Filters were removed in 15.67% of prophylactic and 5.69% of therapeutic filter cases. Complication rates were higher with prophylactic procedures than with therapeutic procedures and typically exceeded 2% in the prophylactic group. Each form of filter placement was associated with increases in all-cause hospitalization (regression coefficient 0.295 95% CI 0.093-0.498, prophylactic; 0.673 95% CI 0.547-0.798, therapeutic) and readmissions (OR 2.444 95% CI 1.298-4.602, prophylactic; 2.074 95% CI 1.644-2.616, therapeutic). IVC filter placement in this managed care population was associated with increased use of anticoagulants and greater healthcare utilization compared to controls, low rates of retrieval, and notable rates of device-related complications, with effects especially pronounced in assessments of prophylactic filters. These findings underscore the need for appropriate use of IVC filters.

Bookmark

View Full Paper