Outcomes and Prognosis Factors in Patients With Vena Cava Filters in a Quaternary Medical Center: A 5-Year Retrospective Analysis

Abstract

Background: Indications for inferior vena cava filter (IVCF) placement are controversial. This study assesses the proportion of different indications for IVCF placement and the associated 30-day event rates and predictors for all-cause mortality, deep vein thrombosis (DVT), pulmonary embolism, and bleeding after IVCF placement. Method: In this 5-year retrospective cohort observational study in a quaternary care center, consecutive patients with IVCF placement were identified through cross-matching of 3 database sets and classified into 3 indication groups defined as “standard” in patients with venous thromboembolism (VTE) and contraindication to anticoagulants, “extended” in patients with VTE but no contraindication to anticoagulants, and “prophylactic” in patients without VTE. Results: We identified 1248 IVCF placements, that is, 238 (19.1%) IVCF placements for standard indications, 583 (46.7%) IVCF placements for extended indications, and 427 (34.2%) IVCF placements for prophylactic indications. Deep vein thrombosis rates [95% confidence interval] were higher in the extended (8.06% [5.98-10.58]) and prophylactic (7.73% [5.38-10.68]) groups than in the standard group (3.36% [1.46-6.52]). Mortality rates were higher in the standard group (12.18% [8.31-17.03]) than in the extended group (7.55% [5.54-9.99]) and the prophylactic (5.85% [3.82-8.52]) group. Bleeding rates were higher in the standard group (4.62% [2.33-8.12]) than in the prophylactic group (2.11% [0.97-3.96]). Best predictors for VTE were acute medical conditions; best predictors for mortality were age, acute medical conditions, cancer, and Medicare health insurance. Conclusions: Prophylactic and extended indications account for the majority of IVCF placements. The standard indication is associated with the lowest VTE rate that may be explained by the competing risk of mortality higher in this group and related to the underlying medical conditions and bleeding risk. In the prophylactic group (no VTE at baseline), the exceedingly high DVT rate may be related to the IVCF placement.

Clinical Observation of Uninterrupted Thrombolytic Therapy via Indwelling Catheter for Lower Limb Deep Vein Thrombosis

“…While the indications and complications of IVCF implantation have always been a concern, more reasonable indications include symptomatic pulmonary embolism, large floating thrombosis in the iliofemoral vein, and contraindications of anticoagulation therapy. 25 IVCF implantation can not only prevent a fatal pulmonary embolism, but also provides a safety guarantee for interventional catheter thrombolytic therapy. 26 We believe that after thrombolysis, the stenosis of the deep vein lumen is more than 50%, and balloon dilation combined with stent implantation should be done with caution.…”

Evaluation of hemodynamic effects of different inferior vena cava filter heads using computational fluid dynamics

“…Both DVT and PE are collectively referred to as venous thromboembolism (VTE) (Yamashita et al, 2022). Currently, systemic anticoagulation is still the preferred method of prevention for VTE OPEN ACCESS EDITED BY Yang Liu, Hong Kong Polytechnic University, Hong Kong SAR, China patients with underlying PE (Duffett and Carrier, 2017;Arslanbekov et al, 2021;Elias et al, 2021). Recent studies have shown that there is no additional benefit of IVCFs deployment in VTE patients with better anticoagulation therapy (Huang et al, 2021).…”