A population-based study of the effectiveness of inferior vena cava filter use among patients with venous thromboembolism

Richard H White, Hong Zhou, Jinwoo Kim, Patrick S Romano

Research output: Contribution to journalArticle

185 Scopus citations

Abstract

Background: There are few population-based data regarding the effectiveness of inferior vena cava filter use in the prevention of symptomatic pulmonary embolism. Objective: To determine the 1-year cumulative incidence of rehospitalization for venous thrombosis or pulmonary embolism among patients with thromboembolism treated with a vena cava filter compared with the incidence in a control population with thromboembolism. Patients and Methods: Population-based retrospective analysis of linked hospital discharge abstracts in California. From January 1,1991, through December 30, 1995, 3632 patients were treated with a filter and 64333 controls were admitted with a principal diagnosis of venous thromboembolism. Results: Filter-treated patients had significantly greater comorbidity, with a higher frequency of previous pulmonary embolism, recent major bleeding, malignant neoplasm, and stroke. Patients who initially manifested pulmonary embolism were significantly more likely to be rehospitalized for pulmonary embolism than patients with an initial diagnosis of venous thrombosis alone, among filter- treated patients (relative risk, 6.72; 95% confidence interval, 3.61-12.49) and controls (relative risk, 5.30; 95% confidence interval, 4.61-6.10). Risk- adjusted proportional hazards modeling showed no significant difference between filter-treated patients and controls in the relative hazard of rehospitalization for pulmonary embolism. However, filter placement was associated with a significantly higher relative hazard of rehospitalization for venous thrombosis among patients who initially manifested pulmonary embolism (relative hazard, 2.62; 95% confidence interval, 2.09-3.29), but not among those who presented with venous thrombosis (relative hazard, 1.14; 95% confidence interval, 0.92-1.43). Conclusions: Insertion of avena cava filter was not associated with a significant reduction in the 1-year incidence of rehospitalization for pulmonary embolism. Use of a filter was associated with a higher incidence of rehospitalization for venous thrombosis, but only among patients who initially manifested pulmonary embolism. A prospective clinical study is needed to determine the efficacy of filter use among patients with pulmonary embolism who do not meet strict guidelines for insertion of a vena cava filter.

Original languageEnglish (US)
Pages (from-to)2033-2041
Number of pages9
JournalArchives of Internal Medicine
Volume160
Issue number13
StatePublished - Jul 10 2000

ASJC Scopus subject areas

  • Internal Medicine

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