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The rate of inferior vena cava filter placement has declined nationally since hitting a high in 2010, National Inpatient Sample data showed.
The rate per 100,000 hospitalizations rose from 322.1 in 2005 to 412.0 in 2010, before steadily declining down to 374.1 in 2011 and 321.8 in 2014, David Brown, MD, of Washington University School of Medicine in St. Louis, and colleagues reported in JAMA Internal Medicine.
The findings mirror those of a recent single-center study, which likewise attributed the shift to a 2010 FDA warning against .
That warning over complication risks with the devices appeared to have reversed a 31-year trend for rising use, Brown's group wrote, noting that shifting indications didn't appear to be responsible. Rates of venous thromboembolism overall didn't drop during the study period.
Both cases with contraindication to anticoagulation -- for which there is the best-quality evidence in VTE -- and without coding for contraindication to anticoagulation dropped per 100,000 hospitalizations after 2010.
Geographic variation seen in the study, with the highest IVC filter use rate in the Mid-Atlantic census area and lowest in the Pacific division, "is consistent with the lack of evidence supporting the use of IVC filters," the researchers noted.
While "absence of effectiveness data does not mean that no patients benefit from IVC filter placement," they concluded, randomized clinical trials are needed to settle the issue.
Disclosures
The study was supported by the National Center for Advancing Translational Sciences, the Agency for Healthcare Research and Quality, and the National Cancer Institute.
Brown and co-authors disclosed no relevant relationships with industry.
Primary Source
JAMA Internal Medicine
Saeed MJ, et al "Trends in inferior vena cava filter placement by indication in the United States from 2005 to 2014" JAMA Intern Med 2017; DOI:10.1001/jamainternmed.2017.5960.