COUNTERPOINT: Do the Benefits Outweigh the Risks for Most Patients Under Consideration for Inferior Vena Cava Filters? No

Lessne, Mark L.; Sing, Ronald F.

doi:10.1016/j.chest.2016.08.1477

Cited by 2 publications

(1 citation statement)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…While some studies have found an overuse of inferior vena cava filters [20], others have suggested their underuse in patients with acute PE [21]. Though guidelines mainly limit their recommendation for inferior vena cava filter insertion to patients with acute symptomatic VTE and a contraindication to anticoagulation, the term "contraindication to anticoagulation" is not well defined and widely open to interpretation and, as such, might have accounted for underuse of filters in patients with PE and a significant bleeding risk [22]. Other reasons might include clinicians' fear of filter-related complications combined with anticipated low retrieval rates.…”

Section: Discussionmentioning

confidence: 99%

Management appropriateness and outcomes of patients with acute pulmonary embolism

et al. 2018

View full text Add to dashboard Cite

The impact of adherence to published guidelines on the outcomes of patients with acute pulmonary embolism (PE) has not been well defined by previous studies.In this prospective cohort study of patients admitted to a respiratory department (n=2096), we evaluated whether patients with PE had better outcomes if they were acutely managed according to international guidelines. Outcomes consisted of all-cause mortality, PE-related mortality, recurrent venous thromboembolism (VTE) and major bleeding events during the first month of follow-up after diagnosis.Overall, 408 patients (19% (95% CI 18-21%)) did not receive guideline-adherent PE management. Patients receiving non-adherent management were significantly more likely to experience all-cause mortality (adjusted odds ratio (OR) 2.39 (95% CI 1.57-3.61) or PE-related mortality (adjusted OR 5.02 (95% CI 2.42-10.42); p<0.001) during follow-up. Non-adherent management was also a significant independent predictor of recurrent VTE (OR 2.19 (95% CI 1.11-4.32); p=0.03) and major bleeding (OR 2.65 (95% CI 1.66-4.24); p<0.001). An external validation cohort of 34 380 patients with PE from the RIETE registry confirmed these findings.PE management that does not adhere to guidelines for indications related to anticoagulation, thrombolytics and inferior vena cava filters is associated with worse patient outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%