Outcomes after Vena Cava Filter Use in Patients with Cancer-Associated Venous Thromboembolism and Contraindications to Anticoagulation

Abstract

<jats:title>Abstract</jats:title><jats:p> Background The association between the use of inferior vena cava filters (IVCFs) and outcomes among patients with cancer-associated thromboembolism (CT) and contraindications to anticoagulation remains unclear.</jats:p><jats:p> Methods In this prospective cohort study of patients with CT from the Registro Informatizado de la Enfermedad TromboEmbólica Registry, we assessed the association between IVCF insertion due to contraindication to anticoagulation and the outcomes of all-cause mortality, pulmonary embolism (PE)-related mortality, recurrent thromboembolism, and major bleeding rates through 30 days after initiation of treatment. We used propensity score matching to adjust for the likelihood of receiving a filter. For outcomes assessment, we implemented generalized estimating equation methods to incorporate the matched-pairs design, and adjusted for covariates that remained unbalanced after matching.</jats:p><jats:p> Results Of the 17,005 patients with CT, 270 underwent IVCF placement because of contraindication to anticoagulation. Of those, 247 were successfully matched with 247 patients treated without a filter. Propensity score-matched pairs showed a nonsignificantly lower risk of all-cause death (12.2% vs. 17.0%; p = 0.13), and a significantly lower risk of PE-related mortality (0.8% vs. 4.0%; p = 0.04) for patients receiving IVCFs compared with those who did not. While there was no significant difference in the rate of major bleeding (6.1% vs. 5.7%; p = 0.85), risk-adjusted recurrent rates were higher for patients who received IVCFs compared with those who did not (7.3% vs. 3.2%; p = 0.05).</jats:p><jats:p> Conclusion In patients with CT and a contraindication to anticoagulation, IVCF insertion was associated with a lower risk of PE-related death, and a higher risk of recurrences.</jats:p>

EHA Guidelines on Management of Antithrombotic Treatments in Thrombocytopenic Patients With Cancer

“…A population-based study of cancer patients with acute lower extremity DVT demonstrated an improvement in PE-free survival on long-term follow-up in patients with IVCF insertion (for any indication) compared to those without (HR, 0.69; 95% CI, 0.64-0.75). 106 The proportion of new DVT among patients who received IVCF was slightly lower than in patients who did not receive IVCF (18.7% versus 22.1%; respectively, P < 0.001). A prospective cohort study of cancer patients with acute PE or lower extremity DVT used propensity score matching to compare 30-day outcomes between patients with IVCF placement because of a significant bleeding risk versus patients without IVCF placement.…”

“…A prospective cohort study of cancer patients with acute PE or lower extremity DVT used propensity score matching to compare 30-day outcomes between patients with IVCF placement because of a significant bleeding risk versus patients without IVCF placement. 107 PE-related mortality was lower with than without filter insertion (0.8% versus 4.0%; respectively, absolute reduction –3.2% [95% CI, –6.5% to –0.5%]). The recurrent VTE rate was higher in the IVCF group than in patients without IVCF (7.3% versus 3.2%; absolute increase 4.1% [95% CI, 0–8.3%].…”

“…Although 14.2% of patients receiving IVCF had grade 1–4 TP (compared to 15.4% in those without IVCF, after matching), there is no data on outcomes in the subgroup of patients with TP in this study or other studies. 107 Accordingly, also the procedure-related risk of bleeding associated with IVCF insertion in this specific population is not known.…”

Current status of treatment of cancer-associated venous thromboembolism

“…In another cohort study, a significant lower risk of PE-related mortality (0.8% vs 4.0%; p = 0.04) were observed in patients receiving IVCF due to contraindication against anticoagulation compared with those who did not, without significant between-group difference regarding the major bleeding rate (6.1% vs 5.7%; p = 0.85). However, recurrent VTE rates were higher in patients who received IVCF compared with those who did not (7.3% vs 3.2%; p = 0.05) [18].…”

2022 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer, including patients with COVID-19

“… 27 Another propensity-matched retrospective study compared the use of inferior vena cava filters in 247 patients with cancer, in whom anticoagulant therapy was contraindicated, with 247 matched patients with cancer but without inferior vena cava filters, reporting a non-significant lower risk of death (12·2% vs 17·0%, p=0·13), and a significantly lower risk of pulmonary embolism-related mortality (0·8% vs 4·0%; p=0·04). 28 …”