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Comment & Response
April 2018

Evidence-Based Rationale for Use of Inferior Vena Cava Filters—Reply

Author Affiliations
  • 1Department of Medicine, University of California San Francisco Medicine, San Francisco
  • 2Editor, JAMA Internal Medicine
JAMA Intern Med. 2018;178(4):574. doi:10.1001/jamainternmed.2018.0061

In Reply Dr Hoffer cites the 2005 PREPIC study1 results to support a benefit in inferior vena cava (IVC) filter placement. He specifically notes “…a 50% decrease in PE risk after IVC filter placement.” Concerns have been raised that this decrease may be exaggerated because symptoms were solicited by study physicians, and patients who were symptomatic were sent for radiologic screening.2 Regardless, this same trial1 showed that the decrease in symptomatic PE came at the cost of increased recurrent deep vein thrombosis and no effect on mortality. Furthermore, the more recent randomized trial of IVC filters, PREPIC II,3 published in 2015, showed a numerically higher rate of recurrent PE in the IVC filter group and again no benefit on mortality for IVC filters.

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