Vena Cava Filter Use in Acute Venous Thromboembolism

Study Questions:

What are the outcomes following vena cava filter use in noncancer patients with acute venous thromboembolism (VTE)?

Methods:

Using a registry of all nonfederal hospitals in California, noncancer patients admitted between 2005 and 2010 with acute VTE were identified. Outcomes (30- and 90-day mortality and 1-year VTE recurrence) were stratified based on the presence/absence of a contraindication to anticoagulation (active bleeding, recent major surgery).

Results:

Among 80,697 patients without a contraindication to anticoagulation, vena cava filter use (n = 7,762, 9.6%) did not significantly reduce the 30-day risk of death (hazard ratio [HR], 1.12; 95% confidence interval [CI], 0.98-1.28). Among the 3,017 patients with active bleeding, vena cava filter use (n = 1,095, 36.3%) reduced 30-day mortality risk (HR, 0.68; 95% CI, 0.52-0.88) and 90-day mortality risk (HR, 0.73; 95% CI, 0.59-0.90). Among the 1,445 patients undergoing major surgery, vena cava filer use (n = 489, 3.8%) did not reduce 30-day mortality (HR, 1.1; 95% CI, 0.71-1.77). In all subgroups, vena cava filter use did not reduce the risk of a subsequent pulmonary embolism, but subsequent deep vein thrombosis risk increased for patients without an anticoagulant contraindication (HR, 1.53; 95% CI, 1.34-1.74) and in patients with active bleeding (HR, 2.35; 95% CI, 1.56-3.52).

Conclusions:

The authors concluded that vena cava filter use significantly reduced the short-term risk of death only among patients with an acute VTE and a contraindication to anticoagulation because of active bleeding.

Perspective:

This study highlights the limitations of widespread vena cava filter use. While use of vena cava filters has been shown to improve outcomes in carefully selected patients, usually with a contraindication to anticoagulation, their routine use has often been associated with more complications than clinical benefit. These findings are supported by major society guidelines, which favor use of vena cava filters only in patients who suffer an acute VTE and have a contraindication to anticoagulation. Clinicians should make every effort to remove all vena cava filters once patients are able to tolerate systemic anticoagulation, in order to avoid complications related to prolonged vena cava filter use.

Clinical Topics: Anticoagulation Management, Prevention, Pulmonary Hypertension and Venous Thromboembolism, Vascular Medicine, Anticoagulation Management and Venothromboembolism

Keywords: Anticoagulants, Hemorrhage, Neoplasms, Primary Prevention, Pulmonary Embolism, Risk, Surgical Procedures, Operative, Thrombosis, Treatment Outcome, Vascular Diseases, Vena Cava Filters, Venous Thromboembolism, Venous Thrombosis


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