An Archives of Internal Medicine report and a U.S. Food and Drug Administration (FDA) advisory that question the long-term safety of inferior vena cava (IVC) filters should give hospitalists pause, one HM leader says.
The Aug. 9 report (PDF) found that the Bard Recovery and Bard G2 filters “had high prevalences of fracture and embolization, with potentially life-threatening sequelae." An FDA advisory issued the same day as the study cautioned that retrievable filters are not always removed from patients once the risk of pulmonary embolism (PE) has subsided, further increasing the risks.
“We’re going to be thinking more than twice before we recommend when these filters are placed in and then thinking twice about when we get them out,” says Shaker Eid, MD, an instructor of medicine at Johns Hopkins University School of Medicine in Baltimore.
Dr. Eid, however, cautions HM leaders about being too fearful of the data. The Archives report, he notes, was a single-center study. And while the FDA reports that the use of filters grew exponentially from 1979 to 2007, new American College of Chest Physicians guidelines from 2008 have limited their use mostly to patients who cannot receive anticoagulation treatments, Dr. Eid notes.
In cases in which they are necessary to implant, or in instances in which a patient already has a permanent IVC filter implanted, Dr. Eid recommends hospitalists be diligent in working with the filter.