Background: Pulmonary embolism (PE) is a deadly complication of deep vein thrombosis. Inferior vena cava filter (IVCF) utilization, one method of preventing PE, has been increasing significantly over the years. Although different guidelines have been established to promote judicious use of IVCFs, the degree of adherence is unclear.

Aims: Analyze indications for IVCF placement at Cedars-Sinai Medical Center (CSMC). Examine adherence to American College of Chest Physicians (ACCP) and Society of Interventional Radiology (SIR) guidelines for IVCF placement at CSMC.

Methods: In a single-center retrospective study, indications were analyzed for seventy-one IVCF placements at CSMC between February and December of 2017. Two experts adjudicated selected cases. Adherence rates for ACCP and SIR guidelines were calculated. Fisher’s exact and t-tests were performed to detect factors that might explain differences in adherence rates.

Results: Adherence rates were 76.1% and 67.6% respectively for SIR and ACCP guidelines. There was a significant difference in adherence to ACCP guidelines when race was a factor (p=0.024). The most common indication for filter placement was acute venous thromboembolism (VTE) with contraindication to anticoagulation (81.5% and 91.7% respectively for SIR and ACCP). The most common reason for filter placement without an accepted indication was acute VTE with perceived contraindication to anticoagulation (52.9% and 39.1% respectively for SIR and ACCP). 31/71 (43.7%) cases required expert adjudication. 25.8% (8/31) of adjudicated cases were deemed to have an accepted indication, 38.7% (12/31) a reasonable indication, and 35.5% (11/31) no specific indication.

Conclusions: Our study found that adherence to established guidelines ranged from 67.6-76.1%. The most common reason for non-adherence was perceived contraindication to anticoagulation. The effect of race on guideline adherence is unclear and more data is needed. Possible measures to improve adherence to guidelines include:
1) consultation with VTE experts,
2) clarity of language in guidelines, and
3) multidisciplinary approach to guideline formulation.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/inferior-vena-cava-filter-ivcf-utilization-quality-assurance-at-a-quaternary-care-medical-center/