Abstract 18182: Inferior Vena Caval Filter Use for Prevention of Pulmonary Embolism: A Systematic Review
Background: Insertion of inferior vena caval filters (IVCFs) has had an 80% increase in 12 years in the US. We sought to meta-analyze high-quality studies of IVCF use for preventing pulmonary embolism (PE).
Methods: We searched PubMed (1950-2016) for randomized controlled trials (RCTs), or observational studies that prospectively included both patients with and without IVCF placement. We searched clinicaltrials.gov to identify ongoing studies. The main outcomes of interest were PE, new deep vein thrombosis (DVT), and mortality. We excluded non-controlled studies.
Results: We screened 1864 publications and identified 11 that met our inclusion/exclusion criteria: 5 RCTs (4 in patients with VTE [PREPIC, PREPIC-II, FILTER-PEVI, and Barginear et al] and 1 for primary prevention [Rajasekhar et al]) , 1 quasi-randomized study (primary prevention: Fullen et al), and 5 prospective controlled observational studies (2 in patients with VTE [RIETE and ICOPER] and 3 for primary prevention [Birkmeyer et al, Gargiulo et al, and Hemmila et al]). Our meta-analysis showed trends toward reduced PE (odds ratio [OR]: 0.52, 95% confidence interval [CI]: 0.24-1.12), significant increase in DVT (OR: 2.02, 95% CI: 1.23-3.32), and no change in mortality (OR: 0.88, 95% CI: 0.52-1.48, Figure). We found no ongoing RCTs on clinicaltrials.gov. Four European registries (RIETE, GARFIELD-VTE, VTEval, and PREFER in VTE) continue to recruit patients.
Conclusions: There are few controlled trials on IVCF placement. The totality of evidence trends toward prevention of PE at the cost of increased DVT. Additional prospective studies are required to identify subgroups that might benefit from IVCFs.
Author Disclosures: B. Bikdeli: None. S. Chatterjee: None. N. Desai: Employment; Significant; Works under contract with the Centers for Medicare & Medicaid Services to develop and maintain performance measures. Other Research Support; Significant; Receives support from Johnson & Johnson to develop methods of clinical trial data sharing and from the Blue Cross Blue Shield Association (BCBSA) to better understand technology evidence generation. M. Desai: None. M. Monreal: None. S. Goldhaber: None. H. Krumholz: Research Grant; Significant; NHLBI, Johnson & Johnson and Medtronic through Yale Universtiy. Consultant/Advisory Board; Significant; United Healthcare.
- © 2016 by American Heart Association, Inc.