Pulmonary embolism treatment widely used despite uncertain benefit

Despite being costly and of little proven benefit, a procedure for treating pulmonary embolism with blood clot filters is routinely used in older adults, Yale School of Medicine researchers and their colleagues found in a new study.

Published in the Journal of the American College of Cardiology, the study also showed that the utilization rates of inferior vena caval (IVC) filters varied widely across different regions in the United States. IVC filters are aimed at obstructing the path of blood clots to prevent pulmonary embolism, a condition in which air or blood clots block blood flow in arteries.

"The best use of the IVC filter technology remains uncertain, but this procedure with very narrow indications is being performed in almost one in six patients," said Bikdeli. "Further research will help identify the subgroups of people that will benefit most from this procedure."

Led by Dr. Behnood Bikdeli, internal medicine resident at Yale School of Medicine, the team studied 550,000 Medicare fee-for-service beneficiaries age 65 or older who were hospitalized for pulmonary embolism between 1999 and 2010. The research team found frequent and increasing use of IVC filters in patients with pulmonary embolism over time, even as death from pulmonary embolism decreased during the same time period, regardless of whether IVC filters were used. They also found that out of the 550,000 older adults with pulmonary embolism, over 15% (94,000) received an IVC filter.

Bikdeli said that IVC filters might be reasonable for a select group of patients, but not for such widespread use.

"Contrary to some common beliefs, they are simply not a bulletproof vest against pulmonary embolism," he said. "Given that this procedure is not devoid of costs or complications, we really need good comparative effectiveness studies to determine which patients may benefit from IVC filters."