Survival Effects of Inferior Vena Cava Filter聽in聽Patients With Acute Symptomatic Venous Thromboembolism and a Significant Bleeding Risk

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• 作者：Alfonso Muriel ; MSc^&lowast ; ; David Jimé ; nez ; MD ; PhD^&dagger ; ; ^{djc_69_98@yahoo.com" class="auth_mail} ; Drahomir Aujesky ; MD^&Dagger ; ; Laurent Bertoletti ; MD^§ ; ; Herve Decousus ; MD^§ ; ; Silvy Laporte ; MD ; PhD^§ ; ; Patrick Mismetti ; MD ; PhD^§ ; ; Francisco J. Muñ ; oz ; MD^鈥?/sup> ; Roger Yusen ; MD^¶ ; ; Manuel Monreal ; MD ; PhD^# ; for the RIETE Investigators
• 关键词：deep vein thrombosis ; prognosis ; pulmonary embolism ; survival ; vena cava filter ; venous thromboembolism
• 刊名：Journal of the American College of Cardiology
• 出版年：29 April 2014
• 年：2014
• 卷：63
• 期：16
• 页码：1675-1683
• 全文大小：470 K

文摘

The purpose of this study was to investigate the survival effects of inferior vena cava filters in patients with venous thromboembolism (VTE) who had a significant bleeding risk.

Background

The effectiveness of inferior vena cava filter use among patients with acute symptomatic VTE and known significant bleeding risk remains unclear.

Methods

In this prospective cohort study of patients with acute VTE identified from the RIETE (Computerized Registry of Patients With Venous Thromboembolism), we assessed the association between inferior vena cava filter insertion for known significant bleeding risk and the outcomes of all-cause mortality, pulmonary embolism (PE)-related mortality, and VTE rates through 30 days after the initiation of VTE treatment. Propensity score matching was used to adjust for the likelihood of receiving a filter.

Results

Of the 40,142 eligible patients who had acute symptomatic VTE, 371 underwent filter placement because of known significant bleeding risk. A total of 344 patients treated with a filter were matched with 344 patients treated without a filter. Propensity score–matched pairs showed a nonsignificant trend toward lower risk of all-cause death for filter insertion compared with no insertion (6.6% vs. 10.2%; p = 0.12). The risk-adjusted PE-related mortality rate was lower for filter insertion than no insertion (1.7% vs. 4.9%; p = 0.03). Risk-adjusted recurrent VTE rates were higher for filter insertion than for no insertion (6.1% vs. 0.6%; p < 0.001).

Conclusions

In patients presenting with VTE and with a significant bleeding risk, inferior vena cava filter insertion compared with anticoagulant therapy was associated with a lower risk of PE-related death and a higher risk of recurrent VTE. However, study design limitations do not imply a causal relationship between filter insertion and outcome.