Efficacy of inferior vena cava filters in anticoagulated patients

Abstract

Summary. Background and objectives: The benefit of an inferior vena cava (IVC) filter in addition to standard anticoagulation regimens is unknown. Methods: We examined data for patients who received IVC filters with anticoagulation (AC‐Filter) after an episode of venous thromboembolism (VTE) and compared them with data for those who received anticoagulation only (AC‐Only). Outcome measures were new pulmonary embolism (PE), recurrent deep vein thrombosis (DVT), and mortality at 90 days and at 5 years. Demographic data included age, gender, and ethnicity/race, prior thromboembolic history, cancer, serum albumin, and time in therapeutic range. In addition, subsets matched for age, gender and race/ethnicity were examined in detail. Results: AC‐Filter patients (n = 251), when compared to AC‐Only patients (n = 1377), did not differ significantly with regard to gender or cancer status, but white males in general had better outcomes. AC‐Filter patients were more likely to have had a previous history of PE or VTE (P < 0.001). In comparison to AC‐Only patients, AC‐Filter patients had lower mean serum albumin levels (3.1 ± 0.8 vs. 3.6 ±0.8 mg dL–1, P < 0.001) and were older (65 ± 16.1 years vs. 60 ± 17.5 years, P < 0.001). After stratification according to previous history of PE or VTE prior to the index VTE event, no differences in the outcome measures of new PE, recurrent DVT or mortality were identified between groups, but patients with a prior history of PE from either group were more likely to have a new PE (hazard ratio 1.9, P < 0.001). Conclusions: These data suggest that IVC filters may not provide any substantial additional benefit for patients who can tolerate anticoagulant therapy.

Experience With Vena Cava Filters at a Large Community Hospital and Level-I Trauma Center

“…This again suggests that IVCF may not provide any substantial additional benefit for patients who can tolerate anticoagulation. 23 The Cochrane Peripheral Vascular Diseases Group reviewed 2 randomized studies involving 529 patients. 24 The first study involving 129 patients with hip fractures 25 showed a reduction in PE rates in the filter group as compared to the control group (4 of 41 vs 19 of 59, relative risk [RR] 0.3, 95% CI 0.11-0.82).…”

Guidelines and the use of inferior vena cava filters: a review of an institutional experience

“…The ACCP 2008 antithrombotic therapy of VTE guidelines recommend against the routine use of a vena cava filter in addition to anticoagulation for initial treatment of DVT and PE [7]. Billett et al [28] recently performed a retrospective study that compared clinical outcomes of patients with VTE who were treated with anticoagulation and filter vs. anticoagulation alone. There were no differences in outcome measures of new PE, recurrent DVT or mortality, but patients with a prior history of PE from either group were more likely to have a new PE.…”

Inferior vena cava filters in the management of cancer-associated venous thromboembolism: a systematic review

“…In a retrospective case-control study Billet et al [58] compared outcomes in 251 patients who received IVC filters in addition to AC (AC-filter) to 1,377 patients on anticoagulation only (AC only). More than 50% of their study population received therapeutic anticoagulation (INR of at least 2) in both the groups for at least 1 year.…”