Outcomes Associated With Inferior Vena Cava Filters Among Patients With Thromboembolic Recurrence During Anticoagulant Therapy.

The aim of this study was to assess the effectiveness of inferior vena cava (IVC) filter use among patients who develop recurrent symptomatic venous thromboembolism (VTE) on anticoagulant therapy. There is a lack of efficacy evidence of IVC filter therapy in patients with VTE recurrence on anticoagulant therapy. In this cohort study of patients with acute VTE identified from the RIETE (Registro Informatizado de la Enfermedad Tromboembólica) registry, the associations between IVC filter placement for VTE recurrence in the first 3 months of anticoagulant therapy and the outcomes of all-cause mortality, pulmonary embolism (PE)-related mortality, second recurrent VTE, and major bleeding rates through 30 days after diagnosis of recurrence were assessed. Among 17 patients treated with filters and 49 matched patients treated without filters for VTE recurrence that presented as deep vein thrombosis, propensity score-matched groups showed no significant differences in death for filter insertion compared with no insertion (17.7% vs. 12.2%; p = 0.56). Among 48 patients treated with filters and 91 matched patients treated without filters for VTE recurrence that presented as PE, propensity score-matched groups showed a significant decrease in all-cause death for filter insertion compared with no insertion (2.1% vs. 25.3%; p = 0.02). The PE-related mortality rate was not significantly lower for filter insertion than no insertion (2.1% vs. 17.6%; p = 0.08), though the point estimates markedly differed. Among patients with VTE recurrence during the first 3 months of anticoagulant therapy, IVC filter insertion was not associated with a survival benefit in patients who recurred with deep vein thrombosis, although it was associated with a lower risk for all-cause death in patients who recurred with PE.

Mellado M ，Pijoan JI ，Jiménez D ，Muriel A ，Aujesky D ，Bertoletti L ，Decousus H ，Barrios D ，Clará A ，Yusen RD ，Monreal M ，RIETE Investigators ... -  《-》

Survival effects of inferior vena cava filter in patients with acute symptomatic venous thromboembolism and a significant bleeding risk.

The purpose of this study was to investigate the survival effects of inferior vena cava filters in patients with venous thromboembolism (VTE) who had a significant bleeding risk. The effectiveness of inferior vena cava filter use among patients with acute symptomatic VTE and known significant bleeding risk remains unclear. In this prospective cohort study of patients with acute VTE identified from the RIETE (Computerized Registry of Patients With Venous Thromboembolism), we assessed the association between inferior vena cava filter insertion for known significant bleeding risk and the outcomes of all-cause mortality, pulmonary embolism (PE)-related mortality, and VTE rates through 30 days after the initiation of VTE treatment. Propensity score matching was used to adjust for the likelihood of receiving a filter. Of the 40,142 eligible patients who had acute symptomatic VTE, 371 underwent filter placement because of known significant bleeding risk. A total of 344 patients treated with a filter were matched with 344 patients treated without a filter. Propensity score-matched pairs showed a nonsignificant 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 for no insertion (6.1% vs. 0.6%; p < 0.001). In patients presenting with VTE and with a significant bleeding risk, inferior vena cava filter insertion compared with anticoagulant therapy was associated with a lower risk of PE-related death and a higher risk of recurrent VTE. However, study design limitations do not imply a causal relationship between filter insertion and outcome.

Muriel A ，Jiménez D ，Aujesky D ，Bertoletti L ，Decousus H ，Laporte S ，Mismetti P ，Muñoz FJ ，Yusen R ，Monreal M ，RIETE Investigators ... -  《-》

Indications, applications, and outcomes of inferior vena cava filters for venous thromboembolism in Japanese patients.

Yamashita Y ，Unoki T ，Takagi D ，Hamatani Y ，Ishii M ，Iguchi M ，Ogawa H ，Masunaga N ，Wada H ，Hasegawa K ，Abe M ，Akao M ... -  《-》

Outcomes after Vena Cava Filter Use in Patients with Cancer-Associated Venous Thromboembolism and Contraindications to Anticoagulation.

 The association between the use of inferior vena cava filters (IVCFs) and outcomes among patients with cancer-associated thromboembolism (CT) and contraindications to anticoagulation remains unclear.  In this prospective cohort study of patients with CT from the Registro Informatizado de la Enfermedad TromboEmbólica Registry, we assessed the association between IVCF insertion due to contraindication to anticoagulation and the outcomes of all-cause mortality, pulmonary embolism (PE)-related mortality, recurrent thromboembolism, and major bleeding rates through 30 days after initiation of treatment. We used propensity score matching to adjust for the likelihood of receiving a filter. For outcomes assessment, we implemented generalized estimating equation methods to incorporate the matched-pairs design, and adjusted for covariates that remained unbalanced after matching.  Of the 17,005 patients with CT, 270 underwent IVCF placement because of contraindication to anticoagulation. Of those, 247 were successfully matched with 247 patients treated without a filter. Propensity score-matched pairs showed a nonsignificantly lower risk of all-cause death (12.2% vs. 17.0%; p = 0.13), and a significantly lower risk of PE-related mortality (0.8% vs. 4.0%; p = 0.04) for patients receiving IVCFs compared with those who did not. While there was no significant difference in the rate of major bleeding (6.1% vs. 5.7%; p = 0.85), risk-adjusted recurrent rates were higher for patients who received IVCFs compared with those who did not (7.3% vs. 3.2%; p = 0.05).  In patients with CT and a contraindication to anticoagulation, IVCF insertion was associated with a lower risk of PE-related death, and a higher risk of recurrences.

Quezada A ，Jiménez D ，Bikdeli B ，Muriel A ，Aramberri M ，López-Jiménez L ，Sahuquillo JC ，Otero R ，Porfidia A ，Monreal M ，RIETE Investigators ... -  《-》

Mid- and long-term outcome of patients with permanent inferior vena cava filters: a single center review.

Inferior vena cava (IVC) filters are used to prevent pulmonary embolism (PE), especially in patients with active contraindication to systemic anticoagulation. The aim of this study is to examine the outcomes of patients who received permanent IVC filters at our institution. This is a single-center retrospective observational study with review of a prospectively collected database for patients who had permanent IVC filters. Patient demographics, indications of filter placement, postprocedure clinical outcome and complications, as well as use of anticoagulant therapy were documented. Chi-squared test was used to test for statistically significant differences (IBM SPSS version 21; IBM Corp., Armonk, NY), while survival was calculated using Kaplan-Meier survival curves analysis. Between February 1998 and December 2013, a total of 109 patients with a median age of 65 (47 men, range 19-97) years had IVC filters inserted at our institution. All of them had documented venous thromboembolism (VTE) before filter placement: 99 (90.8%) had lower extremity deep vein thrombosis (DVT) (including 34 iliac, 65 infrainguinal), 9 (8.3%) had massive PE without evidence of lower limb DVT, and 1 (0.9%) had isolated IVC thrombosis. Forty-seven (43.1%) patients had PE before filter insertion. There were 2 serious procedure-related complications: one access site thrombosis and one right ventricular perforation. With a mean follow-up of 36 ± 33 months, no patient had further symptomatic PE or paradoxical embolism. There were a total of 54 (49.5%) deaths, with a 30-day mortality of 8.3%; none of them was device or procedure related. Among the 92 patients followed up, 27 (29.3%) had further VTE-either DVT in the index or the contralateral lower limb (20 patients, 21.7%), or thrombus inside the filter or the IVC (14 patients, 15.2%). Forty-one (44.6%) patients reported post-thrombotic syndrome (PTS) symptoms. Anticoagulant therapy was given to 39 (42.4%) and 55 (59.8%) patients in the periprocedural period and at any time during the study period, respectively. It did not reduce the rate of postfilter VTE or PTS in both instances. None of the filters in this series was retrieved. This observational study showed that IVC filters were effective in the prevention of PE, although symptomatic postfilter VTE and PTS were common, leading to significant morbidity. Patients who received permanent filters have high mortality on follow-up; however, none were procedure or device related.

Chow FC ，Chan YC ，Cheung GC ，Cheng SW ... -  《-》