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January 2017

Data Desert for Inferior Vena Caval FiltersLimited Evidence, Supervision, and Research

Author Affiliations
  • 1Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Connecticut
  • 2Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, New York
  • 3Section of General Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
  • 4Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
JAMA Cardiol. 2017;2(1):3-4. doi:10.1001/jamacardio.2016.3764

Is there enough evidence to support the use of inferior vena caval filters?—No.

The inferior vena caval (IVC) filter is a widely available medical device that has been used for decades to prevent pulmonary embolism (PE), but studies testing the device have not demonstrated adequate proof of efficacy. Venous thromboembolism (VTE) is the third most common vascular disease after myocardial infarction and stroke, while nearly 1 million patients are diagnosed as having fatal or nonfatal PE annually in the United States and Europe combined. Inferior vena caval filters first received approval by the US Food and Drug Administration (FDA) in 1976, the year the FDA was assigned by Congress to regulate medical devices. The approval came with little supervision on the efficacy of these devices, and the devices have remained FDA-approved ever since. The approval of retrievable filters, with theoretical safety advantages but little proof of net benefit, further fueled the use of IVC filters. Recent evidence indicates that 1 in 6 Medicare beneficiaries with PE receive an IVC filter for secondary prevention.1 The global market of IVC filters should exceed $430 million in 2016.

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