Inferior Vena Cava Filters in Elderly Patients with Stable Acute Pulmonary Embolism.
Am J Med. 2016 Oct 28;:
Authors: Stein PD, Matta F, Hughes MJ
BACKGROUND: Patients >aged 60 years with pulmonary embolism who were stable and did not require thrombolytic therapy were shown to have a somewhat lower in-hospital all-cause mortality with vena cava filters. In this investigation we further assess mortality with filters in stable elderly patients.
METHODS: In-hospital all-cause mortality according to use of inferior vena cava filters was assessed from the National (Nationwide) Inpatient Sample, 2003-2011, in 1) All patients with pulmonary embolism, 2) All with pulmonary embolism who had none of the comorbid conditions listed in the Charlson Comorbidity Index, 3) Patients with a primary (first-listed) diagnosis of pulmonary embolism, and 4) Patients with a primary diagnosis of pulmonary embolism and none of the comorbid conditions listed in the Charlson Comorbidity Index.
RESULTS: From 2003-2012, 2,621,575 stable patients with pulmonary embolism were hospitalized in United States. Patients > aged 80 years showed lower mortality with vena cava filters (all pulmonary embolism, 6.1% versus 10.5%; all pulmonary embolism with no comorbid conditions, 3.3% versus 6.3%; primary pulmonary embolism, 4.1% versus 5.7%; primary pulmonary embolism with no comorbid conditions, 2.1% versus 3.7%)(all P<0.0001). In the all patient category, patients aged 71-80 years showed somewhat lower mortality with filters, 6.3% versus 7.4%, (P<0.0001) and those without comorbid conditions, 2.5% versus 2.8%, (P=0.04). Those aged 71-80 years with primary pulmonary embolism, irrespective of comorbid conditions, did not show lower mortality with filters.
CONCLUSION: At present, in the absence of a randomized controlled trial, it seems prudent to consider a vena cava filter in very elderly (> aged 80 years) stable patients with acute pulmonary embolism.
PMID: 27984007 [PubMed - as supplied by publisher]