Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.20210186
Jornal Vascular Brasileiro
Original Article

Temporal trends in vena cava filter implantation in public health system inpatients: an 11-year analysis of the largest city in Brazil

Tendência temporal do implante de filtro de veia cava em pacientes internados no SUS em São Paulo: análise de 11 anos da maior cidade do Brasil

Dafne Braga Diamante Leiderman; Marcelo Fiorelli; Marcelo Passos Teivelis; Nickolas Stabellini; Edson Amaro Júnior; Nelson Wolosker

Downloads: 0
Views: 1000

Abstract

Abstract: Background: Vena cava filter implantation is considered a simple procedure, which can lead to overuse and over-indication. It is nevertheless associated with short and long-term complications.

Objectives: The goals of this study were to evaluate rates of vena cava filter implantation conducted by Brazil’s Unified Public Health System, analyzing in-hospital mortality and migration of patients from other cities seeking medical attention in São Paulo.

Methods: This study analyzed all vena cava filter procedures conducted from 2008 to 2018 in the city of São Paulo and registered on the public database using a big data system to conduct web scraping of publicly available databases.

Results: A total of 1324 vena cava filter implantations were analyzed. 60.5% of the patients were female; 61.7% were under 65 years old; 34.07% had registered addresses in other cities or states; and there was a 7.4% in-hospital mortality rate.

Conclusions: We observed an increase in the rates of use of vena cava filters up to 2010 and a decrease in rates from that year onwards, which coincides with the year that the Food and Drug Administration published a recommendation to better evaluate vena cava filter indications.

Keywords

inferior vena cava filter, epidemiology, public health system, mortality rate, thrombosis, pulmonary embolism

Resumo

Resumo: Contexto: O implante de filtro de veia cava é considerado um procedimento de baixa complexidade, o que pode resultar em indicação excessiva. No entanto, não é isento de complicações a curto e longo prazo.

Objetivos: Avaliar as taxas de implantes de filtro de veia cava realizados pelo Sistema Único de Saúde e a origem geográfica e mortalidade intra-hospitalar dos pacientes.

Métodos: Foi conduzida uma análise em um banco de dados públicos referente às taxas de implantes de filtro de veia cava realizados de 2008 a 2018 na cidade de São Paulo, utilizando o sistema de big data.

Resultados: Foram analisados 1.324 implantes de filtro de veia cava financiados pelo Sistema Único de Saúde. Identificou-se tendência de aumento da taxa de implantação até 2010 e de redução dos números após esse período. Do total de pacientes, 60,5% eram do sexo feminino; 61,75% tinham menos de 65 anos; e 34,07% possuíam endereço oficial em outra cidade ou estado. A taxa de mortalidade intra-hospitalar foi de 7,4%.

Conclusões: Observamos aumento das taxas de implante de filtro de veia cava até 2010 e redução das taxas após esse período, o que coincide com o ano em que a organização norte-americana Food and Drug Administration publicou uma recomendação para melhor avaliar as indicações de filtros.
 

Palavras-chave

filtro de veia cava, epidemiologia, sistema público de saúde, taxa de mortalidade, trombose, embolia pulmonar

References

1 Spencer FA, Emery C, Lessard D, et al. The Worcester Venous Thromboembolism study: a population-based study of the clinical epidemiology of venous thromboembolism. J Gen Intern Med. 2006;21(7):722-7. http://dx.doi.org/10.1111/j.1525-1497.2006.00458.x. PMid:16808773.

2 Barginear MF, Lesser M, Akerman ML, et al. Need for inferior vena cava filters in cancer patients: a surrogate marker for poor outcome. Clin Appl Thromb Hemost. 2009;15(3):263-9. http://dx.doi.org/10.1177/1076029608315165. PMid:18385149.

3 Zerati AE, Wolosker N, Yazbek G, Langer M, Nishinari K. Vena cava filters in cancer patients: experience with 50 patients. Clinics. 2005;60(5):361-6. http://dx.doi.org/10.1590/S1807-59322005000500003. PMid:16254671.

4 Wolosker N, Varella AYM, Fukuda JM, et al. Enoxaparin Treatment Followed by Rivaroxaban for the Treatment of Acute Lower Limb Venous Thromboembolism: Initial Experience in a Single Center. Clin Appl Thromb Hemost. 2016;22(4):377-80. http://dx.doi.org/10.1177/1076029615621999. PMid:26739543.

5 Pignataro BS, Nishinari K, Cavalcante RN, et al. Oral rivaroxaban for the treatment of symptomatic venous thromboembolism in 400 patients with active cancer. Clin Appl Thromb Hemost. 2017;23(7):883-7. PMid:28027659.

6 Schwarz RE, Marrero AM, Conlon KC, Burt M. Inferior vena cava filters in cancer patients: indications and outcome. J Clin Oncol. 1996;14(2):652-7. http://dx.doi.org/10.1200/JCO.1996.14.2.652. PMid:8636783.

7 Seddighzadeh A, Shetty R, Goldhaber SZ. 1,096 cancer patients with DVT: lower prophylaxis rates but more frequent inferior vena cava filter insertion. Chest. 2007;132(4):499A. http://dx.doi.org/10.1378/chest.132.4_MeetingAbstracts.499.

8 Wang SL, Lloyd AJ. Clinical review: inferior vena cava filters in the age of patient-centered outcomes. Ann Med. 2013;45(7):474-81. http://dx.doi.org/10.3109/07853890.2013.832951. PMid:24099038.

9 Hajduk B, Tomkowski WZ, Malek G, Davidson BL. Vena cava filter occlusion and venous thromboembolism risk in persistently anticoagulated patients: a prospective, observational cohort study. Chest. 2010;137(4):877-82. http://dx.doi.org/10.1378/chest.09-1533. PMid:19880907.

10 The PREPIC Study Group. Eight-year follow-up of patients with permanent vena cava filters in the prevention of pulmonary embolism: the PREPIC (Prevention du Risque d’Embolie Pulmonaire par Interruption Cave) randomized study. Circulation. 2005;112(3):416-22. http://dx.doi.org/10.1161/CIRCULATIONAHA.104.512834. PMid:16009794.

11 Brasil. Centro Cultural do Ministério da Saúde – CCS [site na Internet]. 2021 [cited 2021 nov 8]. http://www.ccs.saude.gov.br/sus20anos/mostra/pdf/painel5.pdf

12 Agência Nacional de Saúde Suplementar – ANS [site na Internet]. 2021 [cited 2021 nov 8]. http://www.ans.gov.br/perfil-do-setor/dados-e-indicadores-do-setor/sala-de-situacao

13 World Health Organization – WHO [site na Internet]. 2021 [cited 2021 nov 8]. http://apps.who.int/nha/database

14 DATASUS [site na Internet]. 2021 [cited 2021 nov 8]. http://tabnet.saude.sp.gov.br/deftohtm.exe?tabnet/aih_rd2008.def.saude.sp.gov.br

15 Charalel RA, Durack JC, Mao J, Ross JS, Meltzer AJ, Sedrakyan A. Statewide inferior vena cava filter placement, complications, and retrievals: epidemiology and recent trends. Med Care. 2018;56(3):260-5. http://dx.doi.org/10.1097/MLR.0000000000000867. PMid:29356721.

16 Power JR, Nakazawa KR, Vouyouka AG, Faries PL, Egorova NN. Trends in vena cava filter insertions and “prophylactic” use. J Vasc Surg Venous Lymphat Disord. 2018;6(5):592-98.e6. http://dx.doi.org/10.1016/j.jvsv.2018.01.018. PMid:29678686.

17 Belkin N, Jackson BM, Foley PJ, et al. Trends in inferior vena cava filter placement and retrieval at a tertiary care institution. J Vasc Surg Venous Lymphat Disord. 2019;7(3):405-12. http://dx.doi.org/10.1016/j.jvsv.2018.11.007. PMid:30885629.

18 Kearon C, Akl EA, Ornelas J, et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest. 2016;149(2):315-52. http://dx.doi.org/10.1016/j.chest.2015.11.026. PMid:26867832.

19 Abdel-Razeq H, Mansour A, Ismael Y, Abdulelah H. Inferior vena cava filters in cancer patients: to filter or not to filter. Ther Clin Risk Manag. 2011;7:99-102. http://dx.doi.org/10.2147/TCRM.S17912. PMid:21479140.

20 Ramacciotti E, Wolosker N, Puech-Leão P, et al. Prevalence of factor V Leiden, FII G20210A, FXIII Val34Leu and MTHFR C677T polymorphisms in cancer patients with and without venous thrombosis. Thromb Res. 2003;109(4):171-4. http://dx.doi.org/10.1016/S0049-3848(03)00179-8. PMid:12757770.

21 Cantelmo NL, Menzoian JO, Logerfo FW, Fasulo G, Mozden PJ. Clinical experience with vena caval filters in high-risk cancer patients. Cancer. 1982;50(2):341-4. http://dx.doi.org/10.1002/1097-0142(19820715)50:2<341::AID-CNCR2820500230>3.0.CO;2-C. PMid:7083141.

22 Dewdney SB, Benn T, Rimel BJ, et al. Inferior vena cava filter placement in the gynecologic oncology patient: a 15-year institutional experience. Gynecol Oncol. 2011;121(2):344-6. http://dx.doi.org/10.1016/j.ygyno.2011.01.004. PMid:21276606.

23 Mansour A, Ismael Y, Abdel-Razeq H. Inferior vena cava filters in patients with advanced-stage cancer. Hematol Oncol Stem Cell Ther. 2014;7(4):136-41. http://dx.doi.org/10.1016/j.hemonc.2014.09.005. PMid:25300564.

24 Matei DE, Marder VJ. Hereditary and acquired thrombophilic syndromes. In: Colman RW, Hirsh J, Marder VJ, Clowes AW, George JN, editors. Hemostasis and thrombosis: basic principles and clinical practice. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2001. 16 p.

25 Krutman M, Wolosker N, Kuzniec S, de Campos Guerra JC, Tachibana A, Almeida Mendes C. Risk of asymptomatic pulmonary embolism in patients with deep venous thrombosis. J Vasc Surg Venous Lymphat Disord. 2013;1(4):370-5. http://dx.doi.org/10.1016/j.jvsv.2013.04.002. PMid:26992758.

26 Kakkar AK. Cancer-associated thrombosis. Br J Cancer. 2010;102(Suppl. 1):S1-1. http://dx.doi.org/10.1038/sj.bjc.6605598. PMid:20386543.

27 Leiderman DBD, Zerati AE, Vieira Mariz MP, Wolosker N, Puech-Leão P, Luccia N. The need for a vena cava filter in oncological patients with acute venous thrombosis: a marker of a worse prognosis. Ann Vasc Surg. 2019;60:35-44. http://dx.doi.org/10.1016/j.avsg.2018.12.085. PMid:30802572.

28 Braga Mendes G, Zanetti G, Marchiori E. Vena cava filter complications. Arch Bronconeumol. 2019;55(3):173-4. PMid:30190226.

29 Alkhouli M, Morad M, Narins CR, Raza F, Bashir R. Inferior vena cava thrombosis. JACC Cardiovasc Interv. 2016;9(7):629-43. http://dx.doi.org/10.1016/j.jcin.2015.12.268. PMid:26952909.

31 Stein PD, Matta F, Hull RD. Increasing use of vena cava filters for prevention of pulmonary embolism. Am J Med. 2011;124(7):655-61. http://dx.doi.org/10.1016/j.amjmed.2011.02.021. PMid:21592452.

32 Spencer FA, Bates SM, Goldberg RJ, et al. A population-based study of inferior vena cava filters in patients with acute venous thromboembolism. Arch Intern Med. 2010;170(16):1456-62. http://dx.doi.org/10.1001/archinternmed.2010.272. PMid:20837832.

33 Zoltowska DM, Thind GS, Agrawal Y, Kalavakunta JK, Joseph S, Patri S. Trends in vena cava filter placement: an analysis of nationwide inpatient sample database over an 11 year period. Rev Recent Clin Trials. 2018;13(4):305-11. http://dx.doi.org/10.2174/1574887113666180626161130. PMid:29952264.

34 Ahmed O, Patel K, Patel MV, et al. Declining national annual IVC filter utilization: an analysis on the impact of societal and governmental communications. Chest. 2017;151(6):1402-4. http://dx.doi.org/10.1016/j.chest.2017.03.038. PMid:28599938.

35 Idakoji I, Kuo W, Deso S. Evidence-based evaluation of inferior vena cava filter complications based on filter type. Semin Intervent Radiol. 2016;33(2):93-100. http://dx.doi.org/10.1055/s-0036-1583208. PMid:27247477.

36 Muriel A, Jiménez D, Aujesky D, et al. Survival effects of inferior vena cava filter in patients with acute symptomatic venous thromboembolism and a significant bleeding risk. J Am Coll Cardiol. 2014;63(16):1675-83. http://dx.doi.org/10.1016/j.jacc.2014.01.058. PMid:24576432.

37 Wadhwa V, Trivedi PS, Chatterjee K, et al. Decreasing Utilization of Inferior Vena Cava Filters in Post-FDA Warning Era: Insights From 2005 to 2014 Nationwide Inpatient Sample. J Am Coll Radiol. 2017;14(9):1144-50. http://dx.doi.org/10.1016/j.jacr.2017.04.022. PMid:28623048.

38 Phair J, Denesopolis J, Lipsitz EC, Scher L. Inferior vena cava filter malpractice litigation: damned if you do, damned if you don’t. Ann Vasc Surg. 2018;50:15-20. http://dx.doi.org/10.1016/j.avsg.2018.01.093. PMid:29526534.

39 Stabellini N, Wolosker N, Leiderman DBD, et al. Epidemiological analysis of carotid artery stenosis intervention during 10 years in the public health system in the largest city in Brazil: stenting has been more common than endarterectomy. Ann Vasc Surg. 2020;66:378. http://dx.doi.org/10.1016/j.avsg.2019.12.040. PMid:31931132.
 


Submitted date:
11/08/2021

Accepted date:
01/26/2022

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
626939faa953954fe83a60f4 jvb Articles
Links & Downloads

J Vasc Bras

Share this page
Page Sections