Author ORCID Identifier

http://orcid.org/0000-0002-2973-1021

Year of Publication

2016

Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation

College

Pharmacy

Department

Pharmaceutical Sciences

First Advisor

Dr. Jeffery C. Talbert

Second Advisor

Dr. Val R. Adams

Abstract

Vena cava filters (VCFs) are mechanical devices implanted in the inferior vena cava to trap thrombi from travelling to the pulmonary circulation, resulting in pulmonary embolism. VCFs are available as permanent or non-permanent, retrievable devices and are generally indicated for use in patients unable to receive systemic anticoagulation or at exceedingly high risk for pulmonary embolism (PE). Retrievable devices allow for removal of the VCF once the contraindication to anticoagulation or high risk of PE has abated. Since the introduction of retrievable VCFs in the early 2000’s, use of VCFs has increased three-fold, with >85% of all VCFs placed being retrievable. Complications due to indwelling VCFs are time-dependent and the FDA-recommended time periods for retrieval fall within 50-70 days post-implantation. However, retrieval rates are low. Generally around 30% of all VCFs are retrieved in eligible patients, with the remainder becoming permanent despite no indication for the VCF to remain in place. These studies sought to quantify the epidemiology of VCF use, and retrieval in Kentucky and nationally, and to inform future clinical interventions to increase retrieval rates. The following objectives were achieved: 1) describe treatment patterns for patients hospitalized with PE or other venous thromboembolism including VCF utilization and anticoagulation, 2) characterize patients who do and do not receive VCFs, 3) evaluate retrieval rates among subgroups of patients and identify factors associated with retrieval, and 4) evaluate a minimal intervention performed in the University of Kentucky hospital aimed at increasing VCF retrieval rates. Finally, a review of the literature was conducted to identify interventions that have increased retrieval rates at individual hospitals. All these data will be useful in developing a future institutional-level intervention to increase retrieval rates to better improve the quality of patient care.

Digital Object Identifier (DOI)

https://doi.org/10.13023/ETD.2016.435

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