The indications for placement of vena cava filters (VCF) have remained the same since their introduction in 1967, that is, for a patient with confirmed venous thromboembolism (VTE) who is at high risk for bleeding with anticoagulant therapy.1 With the increasing ease of placement of VCF including bedside insertion under ultrasonography guidance, their use has steadily increased and the “indications” expanded to include “prophylactic” VCF in patients considered extremely high risk for VTE, especially following trauma.2 The relatively recent introduction of temporary VCF has also helped ease the insertion criteria without the expected decrease in reported rates of pulmonary emboli.2,3 Some recent data would suggest that pulmonary emboli and DVT are not always related and that pulmonary emboli may initiate in the lung as a primary thrombosis, thus rendering a filter ineffective.2 The article by White et al clearly demonstrates that VCF use for established acute VTE varies widely among physician groups, even after controlling for socioeconomic, demographic, and clinical variables. In California, it would appear the risk of receiving a VCF increases with the number of beds in the hospital and with being admitted to a private hospital other than Kaiser. The wide variation in practice among California physicians likely reflects both referral patterns (to vascular surgeons vs radiologists) and the belief (not based on scientific evidence) that a filter is more effective in preventing pulmonary emboli in high-risk patients than adequate anticoagulation.
Knudson MM. Hospital-Specific Risk Factors for Filter Fever. JAMA Surg. 2013;148(7):687–688. doi:10.1001/jamasurg.2013.2286
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