Inferior vena cava filters in patients with cancer and venous thromboembolism (VTE) does not improve clinical outcomes: A population-based study

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

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background There are few studies that have determined clinical outcomes following inferior vena cava filter (IVCF) insertion in cancer patients hospitalized for acute deep-vein-thrombosis (DVT) or pulmonary embolism (PE). Methods and results We analyzed hospital discharge records of all patients with active cancer who were admitted to a California hospital specifically for acute DVT or PE between 2005 through 2009. Propensity and competing risk methodology were used to determine if IVCF-use lowered either 30-day mortality or the risk of recurrent PE, DVT, and major bleeding within 180 days. Among 14,000 patients, an IVCF was placed in 2747 (19.6%), but only 577 (21%) of these IVCF patients had an apparent indication for filter use because of acute bleeding or undergoing major surgery. Data on anticoagulation use was not available. Filter-use provided no reduction in either 30-day mortality (HR = 1.12, 95% CI: 0.99–1.26, p = 0.08) or the adjusted 180-day risk of subsequent PE (± DVT) (HR = 0.81, 95% CI: 0.52–1.27, p = 0.36). Filter use was, however, associated with an increase in the adjusted180-day risk of recurrent DVT (HR = 2.10, 95% CI: 1.53–2.89, p < 0.0001). Conclusions We conclude that in this population-based study, approximately 20% of cancer patients with acute VTE received an IVCF, but only 21% of these had an indication for IVCF use. Overall, IVCF use provided neither a short-term survival benefit nor a reduction in risk of recurrent PE, but IVCF use was associated with a higher risk of recurrent DVT.

Original languageEnglish (US)
Pages (from-to)57-64
Number of pages8
JournalThrombosis Research
Volume153
DOIs
StatePublished - May 1 2017

Fingerprint

Vena Cava Filters
Venous Thromboembolism
Venous Thrombosis
Pulmonary Embolism
Population
Neoplasms
Hemorrhage
Mortality
Hospital Records
Risk Reduction Behavior
Survival

Keywords

  • Cancer
  • Epidemiology
  • Inferior vena cava filter
  • Pulmonary embolism
  • Thrombosis

ASJC Scopus subject areas

  • Hematology

Cite this

@article{d563351b9022471685d91a122de90b36,
title = "Inferior vena cava filters in patients with cancer and venous thromboembolism (VTE) does not improve clinical outcomes: A population-based study",
abstract = "Background There are few studies that have determined clinical outcomes following inferior vena cava filter (IVCF) insertion in cancer patients hospitalized for acute deep-vein-thrombosis (DVT) or pulmonary embolism (PE). Methods and results We analyzed hospital discharge records of all patients with active cancer who were admitted to a California hospital specifically for acute DVT or PE between 2005 through 2009. Propensity and competing risk methodology were used to determine if IVCF-use lowered either 30-day mortality or the risk of recurrent PE, DVT, and major bleeding within 180 days. Among 14,000 patients, an IVCF was placed in 2747 (19.6{\%}), but only 577 (21{\%}) of these IVCF patients had an apparent indication for filter use because of acute bleeding or undergoing major surgery. Data on anticoagulation use was not available. Filter-use provided no reduction in either 30-day mortality (HR = 1.12, 95{\%} CI: 0.99–1.26, p = 0.08) or the adjusted 180-day risk of subsequent PE (± DVT) (HR = 0.81, 95{\%} CI: 0.52–1.27, p = 0.36). Filter use was, however, associated with an increase in the adjusted180-day risk of recurrent DVT (HR = 2.10, 95{\%} CI: 1.53–2.89, p < 0.0001). Conclusions We conclude that in this population-based study, approximately 20{\%} of cancer patients with acute VTE received an IVCF, but only 21{\%} of these had an indication for IVCF use. Overall, IVCF use provided neither a short-term survival benefit nor a reduction in risk of recurrent PE, but IVCF use was associated with a higher risk of recurrent DVT.",
keywords = "Cancer, Epidemiology, Inferior vena cava filter, Pulmonary embolism, Thrombosis",
author = "Ann Brunson and Gwendolyn Ho and White, {Richard H} and Theodore Wun",
year = "2017",
month = "5",
day = "1",
doi = "10.1016/j.thromres.2017.03.012",
language = "English (US)",
volume = "153",
pages = "57--64",
journal = "Thrombosis Research",
issn = "0049-3848",
publisher = "Elsevier Limited",

}

TY - JOUR

T1 - Inferior vena cava filters in patients with cancer and venous thromboembolism (VTE) does not improve clinical outcomes

T2 - A population-based study

AU - Brunson, Ann

AU - Ho, Gwendolyn

AU - White, Richard H

AU - Wun, Theodore

PY - 2017/5/1

Y1 - 2017/5/1

N2 - Background There are few studies that have determined clinical outcomes following inferior vena cava filter (IVCF) insertion in cancer patients hospitalized for acute deep-vein-thrombosis (DVT) or pulmonary embolism (PE). Methods and results We analyzed hospital discharge records of all patients with active cancer who were admitted to a California hospital specifically for acute DVT or PE between 2005 through 2009. Propensity and competing risk methodology were used to determine if IVCF-use lowered either 30-day mortality or the risk of recurrent PE, DVT, and major bleeding within 180 days. Among 14,000 patients, an IVCF was placed in 2747 (19.6%), but only 577 (21%) of these IVCF patients had an apparent indication for filter use because of acute bleeding or undergoing major surgery. Data on anticoagulation use was not available. Filter-use provided no reduction in either 30-day mortality (HR = 1.12, 95% CI: 0.99–1.26, p = 0.08) or the adjusted 180-day risk of subsequent PE (± DVT) (HR = 0.81, 95% CI: 0.52–1.27, p = 0.36). Filter use was, however, associated with an increase in the adjusted180-day risk of recurrent DVT (HR = 2.10, 95% CI: 1.53–2.89, p < 0.0001). Conclusions We conclude that in this population-based study, approximately 20% of cancer patients with acute VTE received an IVCF, but only 21% of these had an indication for IVCF use. Overall, IVCF use provided neither a short-term survival benefit nor a reduction in risk of recurrent PE, but IVCF use was associated with a higher risk of recurrent DVT.

AB - Background There are few studies that have determined clinical outcomes following inferior vena cava filter (IVCF) insertion in cancer patients hospitalized for acute deep-vein-thrombosis (DVT) or pulmonary embolism (PE). Methods and results We analyzed hospital discharge records of all patients with active cancer who were admitted to a California hospital specifically for acute DVT or PE between 2005 through 2009. Propensity and competing risk methodology were used to determine if IVCF-use lowered either 30-day mortality or the risk of recurrent PE, DVT, and major bleeding within 180 days. Among 14,000 patients, an IVCF was placed in 2747 (19.6%), but only 577 (21%) of these IVCF patients had an apparent indication for filter use because of acute bleeding or undergoing major surgery. Data on anticoagulation use was not available. Filter-use provided no reduction in either 30-day mortality (HR = 1.12, 95% CI: 0.99–1.26, p = 0.08) or the adjusted 180-day risk of subsequent PE (± DVT) (HR = 0.81, 95% CI: 0.52–1.27, p = 0.36). Filter use was, however, associated with an increase in the adjusted180-day risk of recurrent DVT (HR = 2.10, 95% CI: 1.53–2.89, p < 0.0001). Conclusions We conclude that in this population-based study, approximately 20% of cancer patients with acute VTE received an IVCF, but only 21% of these had an indication for IVCF use. Overall, IVCF use provided neither a short-term survival benefit nor a reduction in risk of recurrent PE, but IVCF use was associated with a higher risk of recurrent DVT.

KW - Cancer

KW - Epidemiology

KW - Inferior vena cava filter

KW - Pulmonary embolism

KW - Thrombosis

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U2 - 10.1016/j.thromres.2017.03.012

DO - 10.1016/j.thromres.2017.03.012

M3 - Article

C2 - 28334639

AN - SCOPUS:85015642775

VL - 153

SP - 57

EP - 64

JO - Thrombosis Research

JF - Thrombosis Research

SN - 0049-3848

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