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 language | English (US) |
|---|---|
| Pages (from-to) | 57-64 |
| Number of pages | 8 |
| Journal | Thrombosis Research |
| Volume | 153 |
| DOIs | |
| State | Published - May 1 2017 |
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Keywords
- Cancer
- Epidemiology
- Inferior vena cava filter
- Pulmonary embolism
- Thrombosis
ASJC Scopus subject areas
- Hematology
Cite this
Inferior vena cava filters in patients with cancer and venous thromboembolism (VTE) does not improve clinical outcomes : A population-based study. / Brunson, Ann; Ho, Gwendolyn; White, Richard H; Wun, Theodore.
In: Thrombosis Research, Vol. 153, 01.05.2017, p. 57-64.Research output: Contribution to journal › Article
}
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
UR - http://www.scopus.com/inward/record.url?scp=85015642775&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85015642775&partnerID=8YFLogxK
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
ER -