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JACC Cardiovasc Interv. 2016 Dec 12;9(23):2440-2448. doi: 10.1016/j.jcin.2016.08.039. Epub 2016 Nov 9.

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

Author information

1
Angiology and Vascular Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
2
Clinical Epidemiology Unit, BioCruces Health Research Institute, Hospital Universitario Cruces, Bizkaia, CIBER Epidemiología y Salud Pública, Madrid, Spain.
3
Respiratory Department, Hospital Ramón y Cajal, Universidad de Alcalá (IRYCIS), Madrid, Spain. Electronic address: djimenez.hrc@gmail.com.
4
Biostatistics Unit, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria, CIBER Epidemiología y Salud Pública, Madrid, Spain.
5
Department of General Internal Medicine, Bern University Hospital, University of Bern, Bern, Switzerland.
6
Thrombosis Research Group, EA3065, Université de Saint-Etienne, Jean Monnet, Inserm, CIE3, Service de Médecine Interne et Thérapeutique, Hôpital Nord, CHU de Saint-Etienne, Saint-Etienne, France.
7
Respiratory Department, Hospital Ramón y Cajal, Universidad de Alcalá (IRYCIS), Madrid, Spain.
8
Divisions of Pulmonary and Critical Care Medicine and General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri.
9
Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Universidad Católica de Murcia, Murcia, Spain.

Abstract

OBJECTIVES:

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.

BACKGROUND:

There is a lack of efficacy evidence of IVC filter therapy in patients with VTE recurrence on anticoagulant therapy.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

KEYWORDS:

deep vein thrombosis; pulmonary embolism; recurrence; survival; vena cava filter; venous thromboembolism

Comment in

PMID:
27838262
DOI:
10.1016/j.jcin.2016.08.039
[Indexed for MEDLINE]
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