Thrombosis research · 2017
Inferior vena cava filters in patients with cancer and venous thromboembolism (VTE) does not improve clinical outcomes: A population-based study.
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Brunson Ann, Ho Gwendolyn, White Richard, Wun Ted
Аннотация
BACKGROUND: There are few studies that have determined clinical outcomes following inferior vena cava filter (IVCF) insertion in cancer patients hospitalized for acute deep-vein-thrombosis (DVT) or pulmonary embolism (PE).
METHODS AND RESULTS: We analyzed hospital discharge records of all patients with active cancer who were admitted to a California hospital specifically for acute DVT or PE between 2005 through 2009. Propensity and competing risk methodology were used to determine if IVCF-use lowered either 30-day mortality or the risk of recurrent PE, DVT, and major bleeding within 180days. Among 14,000 patients, an IVCF was placed in 2747 (19.6%), but only 577 (21%) of these IVCF patients had an apparent indication for filter use because of acute bleeding or undergoing major surgery. Data on anticoagulation use was not available. Filter-use provided no reduction in either 30-day mortality (HR=1.12, 95% CI: 0.99-1.26, p=0.08) or the adjusted 180-day risk of subsequent PE (±DVT) (HR=0.81, 95% CI: 0.52-1.27, p=0.36). Filter use was, however, associated with an increase in the adjusted180-day risk of recurrent DVT (HR=2.10, 95% CI: 1.53-2.89, p<0.0001).
CONCLUSIONS: We conclude that in this population-based study, approximately 20% of cancer patients with acute VTE received an IVCF, but only 21% of these had an indication for IVCF use. Overall, IVCF use provided neither a short-term survival benefit nor a reduction in risk of recurrent PE, but IVCF use was associated with a higher risk of recurrent DVT.
METHODS AND RESULTS: We analyzed hospital discharge records of all patients with active cancer who were admitted to a California hospital specifically for acute DVT or PE between 2005 through 2009. Propensity and competing risk methodology were used to determine if IVCF-use lowered either 30-day mortality or the risk of recurrent PE, DVT, and major bleeding within 180days. Among 14,000 patients, an IVCF was placed in 2747 (19.6%), but only 577 (21%) of these IVCF patients had an apparent indication for filter use because of acute bleeding or undergoing major surgery. Data on anticoagulation use was not available. Filter-use provided no reduction in either 30-day mortality (HR=1.12, 95% CI: 0.99-1.26, p=0.08) or the adjusted 180-day risk of subsequent PE (±DVT) (HR=0.81, 95% CI: 0.52-1.27, p=0.36). Filter use was, however, associated with an increase in the adjusted180-day risk of recurrent DVT (HR=2.10, 95% CI: 1.53-2.89, p<0.0001).
CONCLUSIONS: We conclude that in this population-based study, approximately 20% of cancer patients with acute VTE received an IVCF, but only 21% of these had an indication for IVCF use. Overall, IVCF use provided neither a short-term survival benefit nor a reduction in risk of recurrent PE, but IVCF use was associated with a higher risk of recurrent DVT.