IVC filters do not help trauma patients survive, according to a study published in January 2017 by JAMA Surgery, suggesting that hospitals should stop routinely implanting IVC filters in these patients.
Trauma patients are an interesting case-study in the controversy over IVC filters. They have a high risk of developing blood clots and dying from pulmonary embolisms, but they usually can’t take blood-thinning medications due to their injury or because they will need surgery.
IVC filters would seem like the perfect solution: implanting a medical device in the inferior vena cava for short-term protection against blood clots, until the patient can take blood-thinners instead.
So when “temporary” IVC filters went mainstream in the mid-2000s, many hospitals started routinely implanting filters in trauma patients, regardless of whether they were actually diagnosed with blood clots yet.
They assumed IVC filters would help patients avoid dying from blood clots, and the result was a skyrocketing number of IVC filter implants — but also reports of people who were injured by major complications.
That assumption is directly contradicted by recent studies. It is one reason why hospitals have started scaling back the use of IVC filters.
The JAMA study was conducted at a Level-1 trauma center at Boston University School of Medicine. The researchers tracked patients who received an IVC filter between 2003 and 2012.
The researchers found that if a patient survived 24 hours, implanting an IVC filter did nothing to extend overall survival for trauma patients. There was still no difference at 6 months and 1 year post-discharge.
In an accompanying opinion piece published in JAMA Cardiology, the researchers wrote:
There is still a need for IVC filter use in certain patients, but that the indiscriminate use of IVCFs without clear indications places patients at risk of serious complications, and we do not support this practice.”
Researchers said IVC filters might help trauma patients with specific types of injuries, but studies are necessary to investigate these possible benefits. Evidence does not support indiscriminately implanting all trauma patients with IVC filters.
Another major problem identified in the study was that only 8% of “temporary” IVC filters in trauma patients were ever actually removed.
The abysmally low retrieval rate is not unique to this hospital. Studies show the overall retrieval rate for IVC filters is under 30%, which includes all patients — not just those recovering from a major injury.
Trauma patients may not even realize they have an IVC filter if it was implanted while they were unconscious. Very few hospitals in the U.S. follow up, which is why many patients never get the filter removed. This is a problem because the risk of complications increases the longer an IVC filter is implanted.