SESSION TITLE: Venous Thromboembolism Posters
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM
PURPOSE: The CDC estimated that for adults over 18 years annual average for hospitalization with VTE was 547,596 between 2007-2009. During that time span an average of average of 28,726 of hospitalized patients with VTE died each year. The purpose of inferior vena cava (IVC) filters is to prevent clinically significant pulmonary embolism. Technology has advanced from surgical interruption and clamping of the inferior vena cava to current percutaneous placement of retrievable IVC filters. Although there are a lack of randomized controlled trials regarding the long-term efficacy and safety of the placement of retrievable IVC filters their use is on the rise. We review the indications and use of inferior vena cava filters in a community-based hospital setting.
METHODS: Retrospective chart review of patients with inferior vena cava filters placed in two inner city community teaching hospitals between May 2012 and December 2013.
RESULTS: 141 patients had inferior vena cava filters placed during the period studied. 61 (43%) retrievable filters were placed and 80 (57%) permanent filters were placed. The primary indications for filter placement included a contraindication to anticoagulation (55%), complication of anticoagulation (11%), prophylactic placement in high-risk patients without DVT (11%) and 12% of filters were placed without an appropriate indication. Failure of anticoagulation (6%), massive PE with DVT (4%) and presence of IVC thrombus (1%) were the remaining reasons for IVC filter placement. Only 3 (5%) of 61 patients with retrievable filters subsequently had them removed. We did not evaluate for complications during this study. Upon review of discharge information, only 33% of discharge instructions, and 57% of discharge summaries included documentation of IVC filter placement. 24% of IVC filters placed were not documented on discharge instructions or summary.
CONCLUSIONS: Our study demonstrated that a high percentage of IVC filters were placed without an appropriate indication (12%), a low percentage of IVC filter retrieval (5%), and poor discharge documentation. In patients with a transient risk of thromboembolic disease, it has been suggested that filter removal be considered within 2 to 3 months of the initial event. Improved documentation and patient education have been associated with improved IVC filter retrieval rate.
CLINICAL IMPLICATIONS: We suspect these issues are not unique to our institutions and that educational efforts may lead to improved patient care outcomes.
DISCLOSURE: The following authors have nothing to disclose: Brett Lindgren, Vivek Mehta, Uyen Hoang, Uzma Khan, Muznay Khawaja, Chandni Bhimani, Ravi Desai, Evan Kurz, Matt Troum, Kevin Turzyen, Michael Korman
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