Original Title: Outcomes after Vena Cava Filter Use in Non-Cancer Patients with Acute Venous Thromboembolism: A Population-Based Study. Reference: Richard H. White et al. Circulation. 2016 Apr 5. Epub ahead of print.
The evidence on the benefits of vena cava filters is limited. This retrospective study analyzed all patients with baseline oncological processes admitted to several centers for venous thromboembolism between 2005 and 2010.
The analysis was stratified according to the presence/absence of counterindication to anticoagulation (active bleeding/recent major surgery).
Primary end point was death at 30/90 days after admission and thromboembolism recurrence manifested as pulmonary embolism or deep vein thrombosis.
Propensity score was used to compare the populations given the systematic differences in baseline characteristics between patients receiving the filter and those who were not.
In 80697 patients with no anticoagulation counterindication, the use of vena cava filters (n=7762, 9.6%) did not significantly reduce mortality at 30 days (HR 1.12; IC 95% 0.98 a 1.28).
Among the 3017 patients with anticoagulation counterindication for active bleeding, the use of vena cava filters (N=1095, 36.3%) reduced mortality at 30 days in 32% (HR 0.68; CI 95% 0.52 a 0.88) and to 90 days a 27% (HR 0.73; 95% CI, 0.59-0.90).
The use of vena cava filters did not reduce mortality in 1445 patients receiving the filter in the context of venous thrombosis and after major surgery (HR 1.1; IC 95% 0.71 a 1.77).
The filter did not reduce thromboembolism subsequent risk of pulmonary embolism in any patient subgroup.
Deep ben thrombosis risk increased 50% in patients that could receive anticoagulation and 135% in those with active bleeding.
Conclusion
The implantation of vena cava filters significantly reduce mortality only in patients with vein thrombosis and anticoagulation counterindication for active bleeding.
