Improving the rate of inferior vena cava filter retrieval through multidisciplinary engagement

Hannah Stevens; Hadley Bortz; Sharon Chao; Radha Ramanan; Warren Clements; Karlheinz Peter; James D McFadyen; Huyen Tran

doi:10.1016/j.rpth.2023.100040

Improving the rate of inferior vena cava filter retrieval through multidisciplinary engagement

Res Pract Thromb Haemost. 2023 Jan 7;7(1):100040. doi: 10.1016/j.rpth.2023.100040. eCollection 2023 Jan.

Authors

Hannah Stevens^{1

2

3}, Hadley Bortz^{1

4}, Sharon Chao¹, Radha Ramanan^{1

2}, Warren Clements^{5

6

7}, Karlheinz Peter^{3

8

9}, James D McFadyen^{1

2

3

9}, Huyen Tran^{1

2}

Affiliations

¹ Department of Haematology, Alfred Hospital, Melbourne, Victoria, Australia.
² Australian Centre for Blood Diseases, Monash University, Melbourne, Victoria, Australia.
³ Atherothrombosis and Vascular Biology Program, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
⁴ Pharmacy Department, Alfred Health, Melbourne, Victoria, Australia.
⁵ Department of Radiology, Alfred Health, Melbourne, Australia.
⁶ Department of Surgery, Monash University Central Clinical School, Melbourne, Australia.
⁷ National Trauma Research Institute, Melbourne, Australia.
⁸ Department of Cardiology, Alfred Hospital, Melbourne, Melbourne, Australia.
⁹ Baker Department of Cardiometabolic Health, The University of Melbourne, Victoria, Australia.

Abstract

Background: The placement of retrievable inferior vena cava (IVC) filters occurs commonly, but retrieval rates remain low. Consequently, there is an unmet clinical need to ensure appropriate follow-up and retrieval of these devices.

Objectives: To determine the association between an IVC filter surveillance team with filter retrievals or a documented filter plan, time to retrieval, and incidence of filter complications or recurrent venous thromboembolism.

Methods: Ambidirectional cohort study evaluating consecutive IVC filter insertions before and after the implementation of a multidisciplinary surveillance team (MDST). We report an odds ratio (OR) with 95% CIs, adjusted by age, sex, weight, and malignancy status.

Results: Overall, 453 patients were included, with 272 individuals in the pre-MDST cohort and 181 individuals in the post-MDST cohort. The MDST was associated with a higher composite primary outcome of IVC filter retrieval or a documented filter plan from 79.4% in the pre-MDST cohort to 96.1% in the post-MDST cohort (OR, 6.44; 95% CI, 3.06-15.84). Compared with the pre-MDST cohort, IVC filter retrieval rates were higher in the post-MDST cohort (52.6%-73.5%, respectively; (OR, 2.50; 95% CI, 1.67-3.78). The MDST was associated with a shorter median time-to-filter retrieval (187-150 days, hazard ratio, 1.78; 95% CI, 1.39-2.29), but there was no significant difference when comparing symptomatic or clinically significant IVC filter complications, recurrent venous thromboembolism, or mortality.

Conclusion: Our study demonstrates the importance of a structured program to ensure timely IVC filter retrieval and ultimately improve patient care.

Keywords: cohort study; patient care; vena cava filters; venous thromboembolism.