Risks and benefits of prophylactic inferior vena cava filters in patients undergoing bariatric surgery

Abstract

BACKGROUND The United States Food and Drug Administration recently issued a warning about adverse events in patients receiving inferior vena cava (IVC) filters. OBJECTIVE To assess relationships between IVC filter insertion and complications while controlling for differences in baseline patient characteristics and medical venous thromboembolism prophylaxis. DESIGN Propensity‐matched cohort study. SETTING The prospective, statewide, clinical registry of the Michigan Bariatric Surgery Collaborative. PATIENTS Bariatric surgery patients (n=35,477) from 32 hospitals during the years 2006 through 2012. INTERVENTION Prophylactic IVC filter insertion. MEASUREMENTS Outcomes included the occurrence of complications (pulmonary embolism, deep vein thrombosis, and overall combined rates of complications by severity) within 30 days of bariatric surgery. RESULTS There were no significant differences in baseline characteristics among the 1,077 patients with IVC filters and in 1,077 matched control patients. Patients receiving IVC filters had higher rates of pulmonary embolism (0.84% vs 0.46%; odds ratio [OR], 2.0; 95% confidence interval [CI], 0.6‐6.5; P=0.232), deep vein thrombosis (1.2% vs 0.37%; OR, 3.3; 95% CI, 1.1‐10.1; P=0.039), venous thromboembolism (1.9% vs 0.74%; OR, 2.7; 95% CI, 1.1‐6.3, P=0.027), serious complications (5.8% vs 3.8%; OR, 1.6; 95% CI, 1.0‐2.4; P=0.031), permanently disabling complications (1.2% vs 0.37%; OR, 4.3; 95% CI, 1.2‐15.6; P=0.028), and death (0.7% vs 0.09%; OR, 7.0; 95% CI, 0.9‐57.3; P=0.068). Of the 7 deaths among patients with IVC filters, 4 were attributable to pulmonary embolism and 2 to IVC thrombosis/occlusion. CONCLUSIONS We have identified no benefits and significant risks to the use of prophylactic IVC filters among bariatric surgery patients and believe that their use should be discouraged. Journal of Hospital Medicine 2013;8:173–177. © 2013 Society of Hospital Medicine

Inferior vena cava filters and postoperative outcomes in patients undergoing bariatric surgery: a meta-analysis

“…Not all studies reported all outcomes. Mortality was not reported in studies by Halmi et al [9] , whereas the cause of death was not specified in all studies except Overby et al and Birkemeyer et al [7,12] .…”

“…Of the 701 selected abstracts, we included 6 studies (n=102767) for the quantitative synthesis ( Figure 1) [7][8][9][10][11][12] . Studies were published between 2006 and 2013, and all patients underwent bariatric surgery ( Table 1).…”

“…One of the authors (DWO) provided additional updated mortality data on his previously published study following IVC filter retrieval [12] . We also used the most recently published outcome data from Birkmeyer et al [7] .…”

“…In the study by Overby et al [12] , clinical assessment of VTE risk was augmented by focused plasma screening for common thrombophilias (factors VIII, IX and XI, D-dimer, fibrinogen, antithrombin III deficiency, protein C/S deficiency, factor V Leiden mutation, anticardiolipin antibodies and lupus anticoagulant). Some of the clinical risk factors for IVC filter placement were accounted for in one study [7] by propensity matching using all of the demographic, weight, medical history, weight-related comorbidity, and procedure-related variables. All patients received pharmacological DVT prophylaxis regardless of preoperative IVC filter placement (Table 2).…”

The efficacy of prophylactic IVC filters in gastric bypass surgery

“…[1,2,6,7,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] We identified 12 retrospective studies about the prophylactic use of IVCF in bariatric surgery. [1,2,6,7,[10][11][12][13][14][15][16]26] One of the studies also had a prospective part in its study design. [11] In addition, one prospective study was found [17].…”