While fewer Americans are receiving IVC blood clot filters, a new study suggests that the devices are far more prevalent among Medicare patients compared to those with private insurance.
IVC filters are implanted in the inferior vena cava to intercept blood clots before they can travel to the heart or lungs. The small wire devices are indicated for patients at risk for pulmonary embolism when they are unable to use standard blood thinning medications.
Many of these filters are designed to be removed when a patient is out of danger. However, recent studies suggest that retrieval is often difficult, if not impossible. As a result, the devices frequently remain implanted far longer than current guidelines recommend.
In 2010, the U.S. Food & Drug Administration (FDA) warned that it had logged more than 900 adverse event reports involving IVC blood clot filters since 2005. Most of the reports described filter migration (328 cases) and embolization (146), while at least 70 patients suffered perforations and 56 experienced blood clot filter fractures.
“These types of events may be related to a retrievable filter remaining in the body for long periods of time, beyond the time when the risk of PE has subsided,” the agency stated.
The FDA updated the alert in May 2014, warning that lower-limb deep vein thrombosis, migration, fracture, perforation, occlusion, and embolization were long-term risks associated with IVC blood clot filters.
“For patients with retrievable filters, some complications may be avoided if the filter can be removed once the risk of pulmonary embolism has subsided,” the agency said. “The FDA is concerned that retrievable IVC filters, when placed for a short-term risk of pulmonary embolism, are not always removed once the risk subsides.”
Previous research has pointed to a sharp decrease in the use of IVC blood clot filters since the FDA issued its first warning in 2010. This new study, which was published online last month by the American Journal of Roentgenology, investigated utilization rates at the state level, and across different payer populations between 2009 and 2015. To do so, its authors identified all billed IVC filter placements from national Medicare data and a proprietary research database of the commercially insured population.
During the study period, IVC filter use fell by 36.3% among Medicare patients and 26.6% among those with private insurance. However, the overall utilization rate among Medicare patients was five-times higher compared to their privately-insured counterparts. And despite the national decline, the use of IVC blood clot filters actually increased among Medicare patients in five states and rose among private insurance patients in seven.
“IVC filter utilization rates vary dramatically by state and payer population, and they likely depend in part on the age of the covered population,” the study authors concluded. “To better identify demographic and socioeconomic drivers of utilization, future research should prioritize nonaggregate multipayer claims-level approaches.”
Thousands of people across the United States are currently pursuing IVC filter lawsuits for injuries and complications they allegedly suffered due to the malfunction of retrievable devices marketed by C.R. Bard, Inc. and Cook Medical, Inc.
More than 6,700 lawsuits involving Bard’s retrievable blood clot filters are undergoing centralized pretrial proceedings in Arizona federal court. The litigation’s first bellwether trial involved the G2 IVC filter and concluded with $3.6 million verdict. However, the company won two subsequent trials involving the Eclipse and G2X filters.
A separate litigation in Indianapolis federal court houses over 5,400 blood clot filter lawsuits filed against Cook Medical. The company won the proceeding’s first bellwether trial in November 2017, while the second bellwether case was dismissed 4 months later. The most recent bellwether trial concluded this past February, when the jury awarded $3 million to a woman who experienced the fracture and migration of Cook’s Celect blood clot filter.
Last May, a Texas state court jury awarded a $1.2 million to another Celect filter recipient.