Survival Effects of Inferior Vena Cava Filter in Patients with Acute Symptomatic Venous Thromboembolism and a Significant Bleeding Risk.
J Am Coll Cardiol. 2014 Feb 24;
Authors: Muriel A, Jiménez D, Aujesky D, Bertoletti L, Decousus H, Laporte S, Mismetti P, Muñoz FJ, Yusen R, Monreal M, RIETE investigators
OBJECTIVES: The purpose of this study was to investigate the survival effects of inferior vena cava filter in patients with venous thromboembolism (VTE) and a significant bleeding risk.
BACKGROUND: The effectiveness of inferior vena cava filter use among patients with acute symptomatic VTE and known significant bleeding risk remains unclear.
METHODS: In this prospective cohort study of patients with acute VTE identified from the RIETE registry, we assessed the association between inferior vena cava filter insertion placed for known significant bleeding risk and the outcomes of all-cause mortality, pulmonary embolism (PE)-related mortality, and VTE rates through 30 days after initiation of VTE treatment. We used propensity score matching to adjust for the likelihood of receiving a filter.
RESULTS: Of the 40,142 eligible patients that had acute symptomatic VTE, 371 underwent filter placement because of known significant bleeding risk. Three hundred and forty four patients treated with a filter were matched with 344 patients treated without a filter. Propensity score-matched pairs showed a non-significant trend toward lower risk of all-cause death for filter insertion compared with no insertion (6.6% vs. 10.2%, P = 0.12). The risk-adjusted PE-related mortality rate was lower for filter insertion than no insertion (1.7% vs. 4.9%, P = 0.03). Risk-adjusted recurrent VTE rates were higher for filter insertion than no insertion (6.1% vs. 0.6%, P > 0.001).
CONCLUSIONS: In patients presenting with VTE and a significant bleeding risk, compared to anticoagulant therapy, IVC filter insertion was associated with a lower risk of PE-related death, while it was associated with a higher risk of recurrent VTE. However, study design limitations do not imply a causal relationship between filter insertion and outcome.
PMID: 24576432 [PubMed - as supplied by publisher]