Outcomes after inferior vena cava filter placement in cancer patients diagnosed with pulmonary embolism: risk for recurrent venous thromboembolism

Abstract

Venous thromboembolism (VTE) is a common complication in cancer patients and anticoagulation (AC) remains the standard of care for treatment. Inferior vena cava (IVC) filters may also used to reduce the risk of pulmonary embolism, either alone or in addition to AC. Although widely used, data are limited on the safety and efficacy of IVC filters in cancer patients. We performed a retrospective review of outcomes after IVC filter insertion in a database of 1270 consecutive patients with cancer-associated pulmonary embolism (PE) at our institution between 2008 and 2009. Outcomes measured included rate of all recurrent VTE, recurrent PE, and overall survival within 12 months. 317 (25%) of the 1270 patients with PE had IVC filters placed within 30 days of the index PE event or prior to the index PE in the setting of prior DVT. Patients with IVC filters had markedly lower overall survival (7.3 months) than the non-IVC filter patients (13.2 months). Filter patients also had a lower rate of AC use at time of initial PE. There was a trend towards higher recurrent VTE in patients with IVC filters (11.9%) compared to non-filter patients (7.7%), but this was not significant (p = 0.086). The risk of recurrent PE was similar between the IVC filter cohort (3.5%) and non-filter group (3.5%, p = 0.99). Cancer patients receiving IVC filters had a similar risk of recurrent PE, but a trend towards more overall recurrent VTE. The filter patients had poorer overall survival, which may reflect a poorer cancer prognosis, and had greater contraindication to AC; therefore these patients likely had a higher inherent risk for recurrent VTE. A prospective study would be helpful for further clarification on the partial reduction in the recurrent PE risk by IVC filter placement in cancer patients.

Inferior vena cava filters (IVCFs): a review of uses and application to international guidelines at a single Australian center; implications of venous thromboembolism associated with malignancy

“…Out of 1270 patients diagnosed with a PE over a one-year period, 317 received an IVCF; however, the indication for insertion was unclear in 23%. 13 …”

Cancer-Associated Thrombosis: Beyond Clinical Practice Guidelines—A Multidisciplinary (SEMI–SEOM–SETH) Expert Consensus

“…While some studies suggested that IVCFs are safe and effective, others found an increased risk of recurrent deep venous thrombosis (DVT; indeed, the cancer-related hypercoagulability is not corrected by the IVCF), as well as no benefit regarding pulmonary embolism (PE) incidence or short-term mortality. [34][35][36][37][38][39][40] Nevertheless, most guidelines recommend the use of IVCF in cancer patients with proximal acute DVT or PE when anticoagulant therapy is contraindicated. [41][42][43][44] Such is the case of major surgery or invasive procedures.…”

“…• Results from studies on the use of IVCF in cancer patients with VTE are controversial. [34][35][36][37][38][39][40] • Consensus exists on its use in patients with PE or DVT when ACG is contraindicated, especially in the first weeks after VTE. [41][42][43][44] • Concern about early and delayed adverse effects associated with IVCF is increasingly growing.…”

Septic and tumor thrombosis caught by inferior vena cava filters and demonstrated on FDG PET/CT

“…The retrievable IVC filter is a commonly used vascular device intended to prevent life-threatening pulmonary emboli, but its effectiveness is not well established. 3 Although many data underscore the efficacy and need of the IVC filter, FDG PET/CT images of the presented cases have illustrated effective capture of the IVC thrombi by the filters.…”