Association of Inferior Vena Cava Filter Placement With Rates of Pulmonary Embolism in Patients With Cancer and Acute Lower Extremity Deep Venous Thrombosis

Abstract

IMPORTANCE Venous thromboembolism is the second overall leading cause of death for patients with cancer, and there is an approximately 2-fold increase in fatal pulmonary embolism (PE) in patients with cancer. Inferior vena cava (IVC) filters are designed to prevent PE, but defining the appropriate use of IVC filters in patients with cancer remains a substantial unmet clinical need. OBJECTIVE To evaluate the association of IVC filters with the development of PE in patients with cancer and deep venous thrombosis (DVT). DESIGN, SETTING, AND PARTICIPANTS A population-based cohort study was conducted using administrative data on 88 585 patients from the state inpatient databases for California (2005-2011) and Florida (2005-2014). Based on diagnostic and procedure codes, patients with cancer and acute lower extremity DVT were identified. All subsequent hospital visits for these patients were evaluated for the placement of an IVC filter, the development of new PE, the development of new DVT, and in-hospital mortality. Data analysis was performed from September 1 to December 1, 2019. EXPOSURES Placement of an IVC filter. MAIN OUTCOMES AND MEASURES The association of IVC filter placement with rates of new PE and DVT was estimated using a propensity score matching algorithm and competing risk analysis. RESULTS The study cohort comprised 88 585 patients (45 074 male; median age, 71.0 years [range, 1.0-104.0 years]) with malignant neoplasms who presented to a health care institution with a diagnosis of acute lower extremity DVT. Of these patients, 33 740 (38.1%) underwent IVC filter placement; patients with risk factors such as upper gastrointestinal bleeding (odds ratio, 1.32; 95%

Effects of CDT on Hemodynamics and Quality of Life in a Subgroup of Patients with Lower Limb Deep Vein Thrombosis Carel: A Case-Control Study

“…It has been reported that the life quality score of patients with PTS is comparable to that of patients with severe chronic diseases such as diabetes and congestive heart failure [ 5 ]. Anticoagulant therapy has always been the standard scheme recommended by some guidelines for the treatment of acute LEDVT [ 6 ].…”

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.…”

Current status of treatment of cancer-associated venous thromboembolism

“…were comparable between DOACs and LMWH groups [15]. In another meta-analysis comparing [17]. 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).…”

“…With respect to IVCF, a cohort study demonstrated that among 33, 740 cancer patients with acute lower extremity DVT and bleeding risk factors who underwent IVCF placement, 4492 patients (5.1%) developed a new PE after the initial DVT diagnosis. A significant improvement was observed in PE-free survival for patients who received IVCF compared with those who did not [ 17 ]. 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).…”