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What the neighbors say

Despite consensus among most experts that vena cava filters rarely, if ever, confer a medical benefit, they continue to be used, the only indication being those with a strong contraindication to anticoagulation. Turner and colleagues (JAMA Network Open) performed a cohort study of such patients. Among 125 000 patients with acute venous thrombosis and a contra-indication identified through large healthcare databases over the last decade, about one third had an inferior vena cava filter implanted. The patients with the filter had a 20% higher 30-day death rate than those without, also after extensive adjustment for confounding by propensity score matching. Such matching cannot resolve group differences due to unknown confounding, and therefore the authors conclude that large randomized trials are needed to definitively settle the question. However, with their findings available, one may wonder whether equipoise still exists, and whether such a trial would be ethical.