Outcomes After Vena Cava Filter Use in Non-Cancer Patients with Acute Venous Thromboembolism: A Population-Based Study
Background—Evidence that vena-cava filters (VCFs) are beneficial is limited.
Methods and Results—We retrospectively analyzed all non-cancer patients admitted to non-federal California hospitals for acute venous thromboembolism (VTE) from 2005-2010. Analysis was stratified by presence/absence of a contraindication-to-anticoagulation (active bleeding, major surgery). Outcomes were death within 30/90 days of admission, and the one-year incidence of recurrent-VTE manifested as pulmonary embolism (PE) or deep-vein thrombosis (DVT). Propensity-score methods were used to account for observed systematic differences in baseline characteristics between patients treated versus not treated with a VCF. Among 80,697 patients with no contraindication-to-anticoagulation, VCF-use (N=7762, 9.6%) did not significantly reduce the 30-day risk of death (HR, 1.12; 95%CI, 0.98-1.28). Among 3,017 patients with active bleeding, VCF-use (N=1095, 36.3%), reduced the 30-day risk of death by 32% (HR, 0.68; 95%CI, 0.52-0.88) and the 90-day risk by 27% (HR, 0.73; 95%CI, 0.59-0.90). VCF-use (N=489, 33.8%) did not reduce mortality among 1445 patients who underwent major surgery (HR, 1.1; 95%CI, 0.71-1.77). In all subgroups filter-use did not reduce the risk of subsequent PE. However, the risk of subsequent DVT increased by 50% among VCF patients with no contraindication (HR, 1.53; 95%CI, 1.34-1.74) and by 135% among VCF patients with active bleeding (HR, 2.35; 95%CI, 1.56-3.52).
Conclusions—VCF-use significantly reduced the short-term risk of death only among patients with acute VTE who had a contraindication-to-anticoagulation because of active bleeding. These results support the findings of a randomized clinical trial and current guidelines, which recommend VCF-use only in patients who cannot receive anticoagulation treatment.
- Received November 9, 2015.
- Revision received March 14, 2016.
- Accepted March 28, 2016.