This is Alan Levy, and I'm honored to be a discussant for Dr. Shapiro and his group's study entitled Prospective Randomized Trial of Temporary IVC Filter in Thrombophilic Patients that Had Cranial or Spinal Surgery. Here are my disclosures, which are non-conflicting. General comments about the study, it's an excellent study. They have a clearly stated hypothesis. The trial design is prospective, randomized, and single-center, and the methods are clearly outlined with two randomized groups, which at the end of the day were remarkably similar with respect to control and treatment arms. The findings, essentially very significant differences with respect to pulmonary embolism, hemorrhagic complications, and sudden death, which were all significantly less in the IVC filter-treated group. The questions that arose from reviewing the presentation is what were the DVT rates in both groups, and why were they not presented? Also, a question arose as to the remarkably low complication rate in the temporary IVC filter group that is not in keeping with published literature. Other groups have reported IVC thrombosis, filter migration, infection, IVC perforation, pulmonary embolism, groin hematoma, and the group should be congratulated on this remarkably low incidence. Finally, it would be very interesting to do a cost assessment comparing the additional cost of doing the temporary IVC filter versus the additional cost burden of the noted complications and deaths in the non-treatment group. Thank you again for allowing me to discuss this paper. Stay safe.

Alan Levy

study

temporary IVC filter

thrombophilic patients

cranial or spinal surgery