Outcome of anticoagulation with rivaroxaban in patients with non-retrieved inferior vena cava filters for the prevention of filter thrombosis: a retrospective cohort study

Abstract

Background Non-retrieved inferior vena cava filter (IVCF) is associated with some severe complications, such as filter thrombosis. The aim of this retrospective cohort study was to evaluate the outcome of rivaroxaban for the prevention of filter thrombosis in patients with non-retrieved IVCF. Methods The study based on the VTE registry databases was limited to patients with non-retrieved IVCF treated at Nanjing Drum Tower Hospital from January 2012 to December 2017. Outcomes included filter thrombosis, total bleeding events, death. Results A total of 202 patients were enrolled in the study and divided into rivaroxaban group and warfarin group. Mean follow-up period of the two groups was 57.4 ± 20.8 and 62.2 ± 23.0 months, respectively. In risk factors for VTE, transient factors (P = 0.008) and history of VTE (P = 0.028) were statistically different between the two groups. A total of 13 (6.4%) patients developed filter complications, of which 4 (3.5%) and 5 (5.7%) patients in rivaroxaban group and warfarin group developed filter thrombosis, respectively, without significant difference (P = 0.690). The total bleeding events in rivaroxaban group, including major bleeding and clinically relevant and non-major (CRNM) bleeding, were significantly lower than that in warfarin group (P = 0.005). Adjusting for hypertension, transient risk factors, history of VTE and cancer, no differences in the hazard ratio for outcomes were notable. Conclusions It is necessary to perform a concomitant anticoagulation in patients with non-retrieved filters. Rivaroxaban can be an alternative anticoagulant option for the prevention of filter thrombosis.

Oral Rivaroxaban Versus Warfarin After inferior Vena cava Filter Implantation: A Retrospective Cohort Study

“… 15 In the study of Wang B et al, the only major gastrointestinal bleeding was reported on rivaroxaban, while in the current study it was not observed. 17 Concerning CRNM bleeding, the figures in the current study were comparable with the previous one but without significant differences with warfarin. Potentially, it is associated with the use of full-dose rivaroxaban in contrast to its reduction after 6 months and the use of an alternative definition for CRNM bleeding.…”

“…16 Recently, Wang B et al published outcomes in 202 patients with permanent IVC filters who received rivaroxaban or warfarin with a mean follow-up of about 60 months. 17 Authors found symptomatic filter thrombosis in 3.5% and 5.7% of patients who received rivaroxaban and warfarin, respectively, without significant differences. To our knowledge, no other studies compared DOACs and VKA after IVC filter implantation.…”

“…In contrast, Wang B et al used a reduced dose of rivaroxaban when they observed a 3.5% rate of filter occlusion. 17 …”

“…Although phase III trials showed similar efficacy and improved safety of DOACs in comparison with vitamin K antagonists (VKAs) in patients with DVT and PE, the evidence on their use after IVC filter implantation is still limited. 15 - 17 …”