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Patrick S Romano - One of the best experts on this subject based on the ideXlab platform.
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high variation between hospitals in Vena Cava Filter use for venous thromboembolism
JAMA Internal Medicine, 2013Co-Authors: Richard H White, Estella Marie Geraghty, Ann Brunson, Susan Murin, Frederick A Spencer, Patrick S RomanoAbstract:Background The extent to which Vena Cava Filter (VCF) use varies between hospitals in the management of acute venous thromboembolism (VTE) is not clear. Methods We conducted a retrospective observational study that compared the frequency of VCF use among California hospitals from January 1, 2006, through December 31, 2010. Using administrative hospital discharge data, we followed explicit criteria to identify nontrauma patients with acute VTE, and determined the frequency of VCF placement in each of the hospitals that admitted more than 55 VTE patients. Multivariable hierarchical regression models to predict VCF use included important clinical and demographic variables as fixed effects and hospital as a random effect. Results Among the 263 hospitals included, 130 643 acute VTE hospitalizations occurred with the placement of 19 537 VCFs (14.95%). Variation in the percentage of acute VTE hospitalizations that included VCF placement was very high, from 0% to 38.96% (interquartile range, 6.23%-18.14%), with 18.49% of the observed variation due to differences among the hospitals that provided care. Significant clinical predictors of VCF use included acute bleeding at the time of admission (odds ratio, 3.4 [95% CI, 3.2-3.6]), a major operation after admission for VTE (3.4 [3.3-3.5]), presence of metastatic cancer (1.7 [1.6-1.8]), and extreme severity of illness (2.5 [2.3-2.7] vs mild). Insertion of VCFs occurred more frequently than expected in 109 hospitals and less frequently in 59. Hospital characteristics associated with VCF use included a small number of beds (odds ratio, 0.2 [95% CI, 0.2-0.4], 400 beds), a rural location (0.4 [0.2-0.5]), and other private vs Kaiser hospitals (1.5 [1.1-2.0]). Use of VCFs varied widely even in geographically proximate areas. Conclusions The frequency of VCF use in patients with acute VTE varied widely and depended on which hospital provided the care, even after adjusting for clinical and socioeconomic factors. Further research is needed to determine whether this variation is associated with local cultural differences between hospitals or with differences in the availability of interventional radiologists or specialists, or whether it reflects the absence of high-quality evidence that VCFs are effective.
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a population based study of the effectiveness of inferior Vena Cava Filter use among patients with venous thromboembolism
JAMA Internal Medicine, 2000Co-Authors: Richard H White, Hong Zhou, Patrick S RomanoAbstract:Background: There are few population-based data regarding the effectiveness of inferior Vena Cava Filter use in the prevention of symptomatic pulmonary embolism.
Fadi Matta - One of the best experts on this subject based on the ideXlab platform.
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Prophylactic inferior Vena Cava Filters in patients with fractures of the pelvis or long bones.
Journal of clinical orthopaedics and trauma, 2017Co-Authors: Paul D. Stein, Fadi Matta, Mary J. HughesAbstract:Abstract Background Which patients with fractures, if any, have a lower mortality with prophylactic inferior Vena Cava Filters has yet to be established. The purpose of this investigation is to determine if patients with low-risk fractures might benefit from a prophylactic inferior Vena Cava Filter. Methods Administrative data was analyzed from the National (Nationwide) Inpatient Sample using ICD-9-CM codes. Included patients were aged 18 years or older with a primary diagnosis of non-complex fracture of the pelvis, or fracture of the femuralone, or fracture of the tibia and/or fibula. Results From 2003–2012, 1,479,039 patients were hospitalized with low-risk fracture. The vast majority of patients with fracture, 1,461,378 of 1,479,039 (98.8%) did not receive an inferior Vena Cava Filter. Among those who did not receive a Filter, 1,446,489 of 1,461,378 (99.0%) did not develop deep venous thrombosis or pulmonary embolism. Pulmonary embolism without a Filter occurred in 7207 of 1,461,378 (0.5%) and deep venous thrombosis occurred in 7682 of 1,461,378 (0.5%). Total in-hospital all-cause mortality in those who did not receive a Filter was 15,683 of 1,461,378 (1.1%). An inferior Vena Cava Filter was inserted in 17,661 of 1,479,039 (1.2%) of patients with fractures. Most of those who received an inferior Vena Cava Filter, 12,025 of 17,661 (68.1%) did not develop pulmonary embolism or deep venous thrombosis. Total in-hospital all-cause mortality in all patients with an inferior Vena Cava Filter was 516 of 17,661 (2.9%). Conclusion The evidence is against the use of a prophylactic inferior Cava Vena Filter in patients with a non-complex pelvic fracture or single fracture of the femur or fracture of the tibia and/or fibula.
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thrombolytic therapy in unstable patients with acute pulmonary embolism saves lives but underused
The American Journal of Medicine, 2012Co-Authors: Paul D. Stein, Fadi MattaAbstract:Abstract Background Data are sparse and inconsistent regarding whether thrombolytic therapy reduces case fatality rate in unstable patients with acute pulmonary embolism. We tested the hypothesis that thrombolytic therapy reduces case fatality rate in such patients. Methods In-hospital all-cause case fatality rate according to treatment was determined in unstable patients with pulmonary embolism who were discharged from short-stay hospitals throughout the United States from 1999 to 2008 by using data from the Nationwide Inpatient Sample. Unstable patients were in shock or ventilator dependent. Results Among unstable patients with pulmonary embolism, 21,390 of 72,230 (30%) received thrombolytic therapy. In-hospital all-cause case fatality rate in unstable patients with thrombolytic therapy was 3105 of 21,390 (15%) versus 23,820 of 50,840 (47%) without thrombolytic therapy ( P 0001). All-cause case fatality rate in unstable patients with thrombolytic therapy plus a Vena Cava Filter was 505 of 6630 (7.6%) versus 4260 of 12,850 (33%) with a Filter alone ( P 0001). Case fatality rate attributable to pulmonary embolism in unstable patients was 820 of 9810 (8.4%) with thrombolytic therapy versus 1080 of 2600 (42%) with no thrombolytic therapy ( P 0001). Case fatality rate attributable to pulmonary embolism in unstable patients with thrombolytic therapy plus Vena Cava Filter was 70 of 2590 (2.7%) versus 160 of 600 (27%) with a Filter alone ( P 0001). Conclusion In-hospital all-cause case fatality rate and case fatality rate attributable to pulmonary embolism in unstable patients was lower in those who received thrombolytic therapy. Thrombolytic therapy resulted in a lower case fatality rate than using Vena Cava Filters alone, and the combination resulted in an even lower case fatality rate. Thrombolytic therapy in combination with a Vena Cava Filter in unstable patients with acute pulmonary embolism seems indicated.
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Impact of Vena Cava Filters on in-hospital case fatality rate from pulmonary embolism.
The American Journal of Medicine, 2012Co-Authors: Paul D. Stein, Fadi Matta, Daniel C. Keyes, Gary WillyerdAbstract:Abstract Background The effects of Vena Cava Filters on case fatality rate are not clear, although they are used increasingly in patients with pulmonary embolism. The purpose of this investigation is to determine categories of patients with pulmonary embolism in whom Vena Cava Filters reduce in-hospital case fatality rate. Methods In-hospital all-cause case fatality rate according to the use of Vena Cava Filters was determined in patients with pulmonary embolism discharged from short-stay hospitals throughout the United States using data from the Nationwide Inpatient Sample. Results In-hospital case fatality rate was marginally lower in stable patients who received a Vena Cava Filter: 21,420 of 297,700 (7.2%) versus 135,240 of 1,712,800 (7.9%) ( P P P P Conclusion At present, it seems prudent to consider a Vena Cava Filter in patients with pulmonary embolism who are receiving thrombolytic therapy and in unstable patients who may not be candidates for thrombolytic therapy. Future prospective study is warranted to better define in which patients a Filter is appropriate.
Jennifer A Mccannbrown - One of the best experts on this subject based on the ideXlab platform.
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short and long term retrievability of the celect Vena Cava Filter results from a multi institutional registry
Journal of Vascular and Interventional Radiology, 2009Co-Authors: Stuart M Lyon, Miguel Angel De Gregorio, William D Voorhees, Guillermo Elizondo Riojas, Raman Uberoi, Jai Patel, Mario Enrique Baltazares Lipp, Graham R Plant, R W Gunther, Jennifer A MccannbrownAbstract:Purpose To evaluate retrievability of the Celect Vena Cava Filter over time and to assess the safety of the retrieval procedure in a prospective multicenter registry. Materials and Methods Between October 2005 and March 2008, Celect Filters were placed in 95 patients (61 men; mean age, 51 years ± 18.5) with a temporary need for an inferior Vena Cava (IVC) Filter. All patients satisfied requirements for Filter placement; the primary indications for placement were pulmonary embolism (PE) with a contraindication to or failure of anticoagulation ( n = 40), high risk for further PE ( n = 29), trauma ( n = 23), or massive PE with residual deep vein thrombosis and risk for further PE ( n = 3). Filter orientation, Vena Cava injury, and other device-related incidents were evaluated at implantation and retrieval. The degree of difficulty associated with retrieval was also assessed. Results Filter retrieval was attempted in 58 patients (mean indwell time of 179 days; median, 168.5 d; range, 5–466 d). Fifty-six Filters (96.6%) were successfully retrieved. Unsuccessful retrieval attempts were attributed to Filter tilt ( n = 1) or excessive tissue growth with the hook embedded in the endothelium ( n = 1). No adverse events were associated with the inability to retrieve these Filters. A Kaplan-Meier product-limit survival estimate revealed that the probability of successful Filter retrieval remained at 100% at 50 weeks and at more than 74% at 55 weeks after implantation. No adverse events were related to the retrieval procedures. Conclusions Retrieval of the Celect Filter was performed safely as long as 466 days after implantation.
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long term retrieval success rate profile for the gunther tulip Vena Cava Filter
Journal of Vascular and Interventional Radiology, 2009Co-Authors: Bob H Smouse, David Rosenthal, Michael F Knox, Robert G Dixon, William D Voorhees, Jennifer A MccannbrownAbstract:Purpose To evaluate the likelihood of successful retrieval of the Gunther Tulip Vena Cava Filter after various implant durations (up to 494 days). Materials and Methods Retrievable Gunther Tulip Filters were placed in 554 patients. All patients satisfied requirements for Filter placement; the primary indication for placement was specified for 394 patients (71%), as follows: unspecified trauma ( n = 164), bariatric procedures ( n = 128), orthopedic procedures ( n = 36), and other ( n = 66). Filter tilt and Vena Cava injury were assessed at implantation. Filters were not repositioned after placement. At retrieval, Filter orientation, Vena Cava injury, other device-related incidents, and the degree of difficulty associated with retrieval were reported. Results Filter retrieval was attempted in 275 patients and successful in 248 (90.2%). The mean Filter indwell time was 58.9 days (range, 3–494 days). Unsuccessful retrievals ( n = 27) were attributed primarily to improper hook orientation ( n = 10) or excessive tissue in-growth at the Filter legs ( n = 16). Of the remaining 279 patients, 223 withdrew from the study, 41 were associated with a decision to keep the Filter as a permanent device, 13 died for reasons unrelated to the study, and two had no reported endpoint data. A Kaplan-Meier product-limit survival estimate revealed that the probability of successful device retrieval remained greater than 94% at 12 weeks and greater than 67% at 26 weeks. Conclusions This study contributes to the body of clinical data related to retrievable Filters, demonstrating reliable retrieval rates at 12 weeks, with successful retrievals up to 17 months after implantation.
Richard H White - One of the best experts on this subject based on the ideXlab platform.
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high variation between hospitals in Vena Cava Filter use for venous thromboembolism
JAMA Internal Medicine, 2013Co-Authors: Richard H White, Estella Marie Geraghty, Ann Brunson, Susan Murin, Frederick A Spencer, Patrick S RomanoAbstract:Background The extent to which Vena Cava Filter (VCF) use varies between hospitals in the management of acute venous thromboembolism (VTE) is not clear. Methods We conducted a retrospective observational study that compared the frequency of VCF use among California hospitals from January 1, 2006, through December 31, 2010. Using administrative hospital discharge data, we followed explicit criteria to identify nontrauma patients with acute VTE, and determined the frequency of VCF placement in each of the hospitals that admitted more than 55 VTE patients. Multivariable hierarchical regression models to predict VCF use included important clinical and demographic variables as fixed effects and hospital as a random effect. Results Among the 263 hospitals included, 130 643 acute VTE hospitalizations occurred with the placement of 19 537 VCFs (14.95%). Variation in the percentage of acute VTE hospitalizations that included VCF placement was very high, from 0% to 38.96% (interquartile range, 6.23%-18.14%), with 18.49% of the observed variation due to differences among the hospitals that provided care. Significant clinical predictors of VCF use included acute bleeding at the time of admission (odds ratio, 3.4 [95% CI, 3.2-3.6]), a major operation after admission for VTE (3.4 [3.3-3.5]), presence of metastatic cancer (1.7 [1.6-1.8]), and extreme severity of illness (2.5 [2.3-2.7] vs mild). Insertion of VCFs occurred more frequently than expected in 109 hospitals and less frequently in 59. Hospital characteristics associated with VCF use included a small number of beds (odds ratio, 0.2 [95% CI, 0.2-0.4], 400 beds), a rural location (0.4 [0.2-0.5]), and other private vs Kaiser hospitals (1.5 [1.1-2.0]). Use of VCFs varied widely even in geographically proximate areas. Conclusions The frequency of VCF use in patients with acute VTE varied widely and depended on which hospital provided the care, even after adjusting for clinical and socioeconomic factors. Further research is needed to determine whether this variation is associated with local cultural differences between hospitals or with differences in the availability of interventional radiologists or specialists, or whether it reflects the absence of high-quality evidence that VCFs are effective.
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a population based study of the effectiveness of inferior Vena Cava Filter use among patients with venous thromboembolism
JAMA Internal Medicine, 2000Co-Authors: Richard H White, Hong Zhou, Patrick S RomanoAbstract:Background: There are few population-based data regarding the effectiveness of inferior Vena Cava Filter use in the prevention of symptomatic pulmonary embolism.
U Gullotta - One of the best experts on this subject based on the ideXlab platform.
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current practice of temporary Vena Cava Filter insertion a multicenter registry
Journal of Vascular and Interventional Radiology, 2000Co-Authors: Heike Lorch, D Welger, V Wagner, B Hillner, E P Strecker, H Herrmann, G Voshage, C Schwarzbach, J Schroder, U GullottaAbstract:PURPOSE: To evaluate the current practice of temporary Vena Cava Filter placement and its complications. MATERIALS AND METHODS: A multicenter registry was conducted from May 1995 until May 1997 using a standardized questionnaire. One hundred eighty-eight patients were evaluated. Patient characteristics, Filter indications, Filter characteristics, and complications were registered. RESULTS: Deep vein thrombosis was proven in 95.2% of the patients. Main Filter indication was thrombolysis therapy (53.1%). Average Filter time was 5.4 days. An Antheor Filter was inserted in 56.4%, a Guenther Filter in 26.6%, and a Prolyser Filter in 17.%. Transfemoral Filter implantation was slightly preferred (54.8%). Four patients died of pulmonary embolism (PE) during Filter protection. Major Filter problems were Filter thrombosis (16%) and Filter dislocation (4.8%). When thrombus was found in or at the Filter before explantation, additional thrombolysis was performed in 16.7%, additional Filter implantation in 10%, and thrombus aspiration in 6.7%; 4.8% of Filters were replaced with permanent Filters. DISCUSSION: Temporary Vena Cava Filters are placed to prevent PE in a defined patient population. Despite their presence, PEs still occur in a small percentage. Problems of Filter thrombosis and dislocation have to be solved. CONCLUSION: The results of this multicenter registry support the need for innovative Filter design, as well as a randomized, prospective study.