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Medical literature and vena cava filters: so far so weak
Philippe Girard1, Jean-Baptiste Stern, Florence Parent
1Département thoracique, Institut Mutualiste Montsouris, Paris, France. philippe.girard@imm.fr
Insights
Indications for inferior vena cava (IVC) filter placement lack robust evidence due to a scarcity of high-quality studies. Most available literature consists of retrospective reports, hindering definitive conclusions on filter use for venous thromboembolism.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Cardiology
Background:
- Inferior vena cava (IVC) filters are increasingly used to prevent venous thromboembolism.
- Percutaneous placement has become a common procedure for patients at risk.
- Clarifying indications for IVC filter placement is crucial.
Purpose of the Study:
- To systematically review the literature regarding indications for IVC filter placement.
- To assess the quality and quantity of evidence supporting IVC filter use.
Main Methods:
- A systematic MEDLINE search was conducted for articles published between 1975 and 2000.
- References were analyzed based on predetermined criteria.
- Searches also included literature on heparin for comparison.
Main Results:
- Out of 568 references on IVC filters, 65% were retrospective studies or case reports.
- Only 7.4% were prospective studies, with few including over 100 patients.
- A single randomized controlled trial (0.02%) was identified, with significant heterogeneity precluding comparisons.
- In contrast, 47.4% of heparin-related references were randomized controlled trials.
Conclusions:
- The current literature on IVC filters is largely narrative.
- High-quality evidence supporting indications for filter placement is lacking.
- Many indications for IVC filter use remain based on opinion rather than data.
Study Objective:
With the development of percutaneous inferior vena cava (IVC) filters, IVC interruption has become a widely used procedure in patients with or at risk for venous thromboembolism. In an attempt at clarifying the indications for filter placement, a systematic literature review was undertaken.
Design:
Bibliographic search and analysis.
Measurements And Results:
A systematic MEDLINE search about vena cava filters produced a total of 568 references with abstracts between 1975 and 2000 inclusively. Each reference was analyzed according to predetermined criteria. Nearly two thirds (65.0%) of these publications were retrospective studies or case reports (33.3 and 31.7%, respectively), 12.9% were animal or in vitro studies, 7.4% were prospective studies, 6.7% were reviews, and 8.1% reported on miscellaneous related topics. Among the prospective studies, only 16 studies included > or = 100 patients, only 1 study was a randomized controlled trial (0.02% of 568 references), and heterogeneity among series precluded any relevant comparison. In a similar search about heparin and venous thromboembolism, 47.4% of 531 references were randomized controlled trials.
Conclusions:
Until more relevant data become available, literature reviews about vena cava filters will remain narrative, and many if not most indications for filter placement will remain a matter of opinion.