Inferior vena cava filters in patients with cancer and venous thromboembolism (VTE): Patterns of use and outcomes

Ann Brunson, Gwendolyn Ho, Richard H White, Theodore Wun

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background Few studies have evaluated the use and outcomes of inferior vena cava filters (IVCF) insertion in cancer patients with deep venous thrombosis (DVT) or pulmonary embolism (PE). Methods Hospital records of patients with a principal diagnosis of lower extremity DVT and/or PE and cancer in California between January 1, 2005 and December 31, 2009 were analyzed. Multivariable logistic regression analysis was used to identify variables associated with IVCF use and propensity matched methodology was used to determine the effect of IVCF insertion on clinical outcomes. Results An IVCF was placed in 19.6% of 14,000 cancer patients and VTE. This varied widely across hospitals, from 0% to 52%, and by cancer type. The strongest predictors of IVCF use were a diagnosis of brain cancer (OR = 4.6, CI: 3.7-5.6), undergoing major surgery (OR = 4.9, CI: 3.9-6.1), and bleeding (OR = 2.7, CI: 2.0-3.5). Only 21% of patients with IVCF had a strong contraindication to anticoagulation (bleeding or major surgery). There was no benefit for 30-day mortality and no reduction in subsequent PE (+/- DVT). Additionally, there was 60% increased risk of recurrent DVT and 20% increased risk of subsequent bleeding when an IVCF was placed. Conclusions An IVCF was placed in approximately 20% of acute VTE patients with cancer and use varied widely between hospitals and cancer types. Most patients did not have a contraindication for anticoagulation. There was no benefit in short-term mortality or risk of PE; there was increased risk of DVT and subsequent bleeding.

Original languageEnglish (US)
Pages (from-to)S132-S141
JournalThrombosis Research
Volume140
DOIs
StatePublished - Apr 1 2016

Fingerprint

Vena Cava Filters
Venous Thromboembolism
Venous Thrombosis
Pulmonary Embolism
Neoplasms
Hemorrhage
Cancer Care Facilities
Mortality
Hospital Records
Brain Neoplasms
Lower Extremity
Lung Neoplasms
Logistic Models
Regression Analysis

Keywords

  • Cancer and thrombosis
  • Deep venous thrombosis
  • Inferior vena cava filter
  • Outcomes
  • Pulmonary embolism
  • Venous thromboembolism

ASJC Scopus subject areas

  • Hematology

Cite this

Inferior vena cava filters in patients with cancer and venous thromboembolism (VTE) : Patterns of use and outcomes. / Brunson, Ann; Ho, Gwendolyn; White, Richard H; Wun, Theodore.

In: Thrombosis Research, Vol. 140, 01.04.2016, p. S132-S141.

Research output: Contribution to journalArticle

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title = "Inferior vena cava filters in patients with cancer and venous thromboembolism (VTE): Patterns of use and outcomes",
abstract = "Background Few studies have evaluated the use and outcomes of inferior vena cava filters (IVCF) insertion in cancer patients with deep venous thrombosis (DVT) or pulmonary embolism (PE). Methods Hospital records of patients with a principal diagnosis of lower extremity DVT and/or PE and cancer in California between January 1, 2005 and December 31, 2009 were analyzed. Multivariable logistic regression analysis was used to identify variables associated with IVCF use and propensity matched methodology was used to determine the effect of IVCF insertion on clinical outcomes. Results An IVCF was placed in 19.6{\%} of 14,000 cancer patients and VTE. This varied widely across hospitals, from 0{\%} to 52{\%}, and by cancer type. The strongest predictors of IVCF use were a diagnosis of brain cancer (OR = 4.6, CI: 3.7-5.6), undergoing major surgery (OR = 4.9, CI: 3.9-6.1), and bleeding (OR = 2.7, CI: 2.0-3.5). Only 21{\%} of patients with IVCF had a strong contraindication to anticoagulation (bleeding or major surgery). There was no benefit for 30-day mortality and no reduction in subsequent PE (+/- DVT). Additionally, there was 60{\%} increased risk of recurrent DVT and 20{\%} increased risk of subsequent bleeding when an IVCF was placed. Conclusions An IVCF was placed in approximately 20{\%} of acute VTE patients with cancer and use varied widely between hospitals and cancer types. Most patients did not have a contraindication for anticoagulation. There was no benefit in short-term mortality or risk of PE; there was increased risk of DVT and subsequent bleeding.",
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T1 - Inferior vena cava filters in patients with cancer and venous thromboembolism (VTE)

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AU - Brunson, Ann

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AU - White, Richard H

AU - Wun, Theodore

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N2 - Background Few studies have evaluated the use and outcomes of inferior vena cava filters (IVCF) insertion in cancer patients with deep venous thrombosis (DVT) or pulmonary embolism (PE). Methods Hospital records of patients with a principal diagnosis of lower extremity DVT and/or PE and cancer in California between January 1, 2005 and December 31, 2009 were analyzed. Multivariable logistic regression analysis was used to identify variables associated with IVCF use and propensity matched methodology was used to determine the effect of IVCF insertion on clinical outcomes. Results An IVCF was placed in 19.6% of 14,000 cancer patients and VTE. This varied widely across hospitals, from 0% to 52%, and by cancer type. The strongest predictors of IVCF use were a diagnosis of brain cancer (OR = 4.6, CI: 3.7-5.6), undergoing major surgery (OR = 4.9, CI: 3.9-6.1), and bleeding (OR = 2.7, CI: 2.0-3.5). Only 21% of patients with IVCF had a strong contraindication to anticoagulation (bleeding or major surgery). There was no benefit for 30-day mortality and no reduction in subsequent PE (+/- DVT). Additionally, there was 60% increased risk of recurrent DVT and 20% increased risk of subsequent bleeding when an IVCF was placed. Conclusions An IVCF was placed in approximately 20% of acute VTE patients with cancer and use varied widely between hospitals and cancer types. Most patients did not have a contraindication for anticoagulation. There was no benefit in short-term mortality or risk of PE; there was increased risk of DVT and subsequent bleeding.

AB - Background Few studies have evaluated the use and outcomes of inferior vena cava filters (IVCF) insertion in cancer patients with deep venous thrombosis (DVT) or pulmonary embolism (PE). Methods Hospital records of patients with a principal diagnosis of lower extremity DVT and/or PE and cancer in California between January 1, 2005 and December 31, 2009 were analyzed. Multivariable logistic regression analysis was used to identify variables associated with IVCF use and propensity matched methodology was used to determine the effect of IVCF insertion on clinical outcomes. Results An IVCF was placed in 19.6% of 14,000 cancer patients and VTE. This varied widely across hospitals, from 0% to 52%, and by cancer type. The strongest predictors of IVCF use were a diagnosis of brain cancer (OR = 4.6, CI: 3.7-5.6), undergoing major surgery (OR = 4.9, CI: 3.9-6.1), and bleeding (OR = 2.7, CI: 2.0-3.5). Only 21% of patients with IVCF had a strong contraindication to anticoagulation (bleeding or major surgery). There was no benefit for 30-day mortality and no reduction in subsequent PE (+/- DVT). Additionally, there was 60% increased risk of recurrent DVT and 20% increased risk of subsequent bleeding when an IVCF was placed. Conclusions An IVCF was placed in approximately 20% of acute VTE patients with cancer and use varied widely between hospitals and cancer types. Most patients did not have a contraindication for anticoagulation. There was no benefit in short-term mortality or risk of PE; there was increased risk of DVT and subsequent bleeding.

KW - Cancer and thrombosis

KW - Deep venous thrombosis

KW - Inferior vena cava filter

KW - Outcomes

KW - Pulmonary embolism

KW - Venous thromboembolism

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