Clinical Research
Venous Thromboembolism
Survival Effects of Inferior Vena Cava Filter in Patients With Acute Symptomatic Venous Thromboembolism and a Significant Bleeding Risk

https://doi.org/10.1016/j.jacc.2014.01.058Get rights and content
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Objectives

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.

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 (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.

Results

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).

Conclusions

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.

Key Words

deep vein thrombosis
prognosis
pulmonary embolism
survival
vena cava filter
venous thromboembolism

Abbreviations and Acronyms

AD
absolute difference
AUC
area under the curve
CI
confidence interval
CT
computed tomography
DVT
deep vein thrombosis
Hb
hemoglobin
IVC
inferior vena cava
LMWH
low-molecular-weight heparin
PE
pulmonary embolism
UFH
unfractionated heparin
VTE
venous thromboembolism

Cited by (0)

The RIETE registry was supported by an unrestricted educational grant from Sanofi Spain and by Bayer Pharma AG. (Bayer Pharma AG's support was limited to the part of the RIETE registry outside of Spain, which accounts for approximately 18% to 19% of the total patients.) Dr. Yusen has received grants from Bayer HealthCare Pharmaceuticals, Inc., Portola, Inc., Pfizer, Inc., and Bristol-Myers Squibb; has received consulting fees from Bayer HealthCare, Bristol-Myers Squibb, and GlaxoSmithKline; has served as a legal consultant for Ortho Pharmaceuticals, Inc., Organon, Inc., Pfizer, Portola, and Sanofi-Aventis; and was a member of the Data Safety Monitoring Board for a National Institutes of Health, National Heart, Lung, and Blood Institute–funded trial. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Muriel and Jiménez contributed equally to this work.