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Pulmonary embolisms

Prophylatic IVC filter insertion: “more risks than benefits”

Birkmeyer et al said that the risks associated with IVC filters in bariatric patients means the practice "should be discouraged".
Patients who received IVC filters in study had higher rate of complications and mortality
New study backs up previous research questioning benefits of installing IVC filters in bariatric patients

The risks of inserting prophylactic inferior vena cava (IVC) filters in bariatric patients exceed the benefits, and the practice should be discouraged, according to a new study.

The study, “Peri-operative complications in bariatric surgery patients undergoing prophylactic inferior vena cava filter insertion”, found that patients who received a filter had higher adjusted rates of venous thromboembolism, serious complications, and death.

The research was presented at the ASMBS' 29th annual meeting in San Diego.

The new study follows advice from the US Food and Drug Administration that such filters should be removed as soon as protection from pulmonary embolisms is no longer needed, as extended insertions can lead to complications like lower limb deep vein thrombosis, filter fracture, filter migration, filter embolization and inferior vena cava perforation.

The study, performed by Birkmeyer et al, analysed data from 29,326 patients included in the prospective statewide clinical registry of the Michigan Bariatric Surgery Collaborative, between 2006 and 2011.

Researchers used logistic regression to assess relationships between IVC filter insertion and complications within 30 days of surgery, while controlling for patient risk factors, bariatric procedure type, and propensity score.

3.5% of the patients (1,018) underwent filter placement before their operation, 62% of whom had no history of venous thromboembolism.

0.43% of patients with IVC filters had venous thromboembolism, compared to 0.21% in the population of patients without filters (p=0.019). 2.8% of the IVC group had serious complications; only 2.0% of patients without IVC filters did (p = 0.038).

The mortality rate in the IVC and non-IVC groups was 0.2% and 0.05% respectively (p=0.013). Of the patients with IVC filters that died, four had pulmonary embolism and two had IVC thrombosis/occlusion. Other serious IVC filter specific complications included IVC filter migration in two patients.

The study is the second that the group has performed concerning IVC filters in bariatric patients; the first, in 2010, found a lack of benefit of filter insertion for the prevention of pulmonary embolism in bariatric patients, but did not have the statistical power to prove harms associated with the practice.

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