A five-year, retrospective, comparison review of survival in neurosurgical patients diagnosed with venous thromboembolism and treated with either inferior vena cava filters or anticoagulants.
BACKGROUND
[corrected] The optimal role of inferior vena cava filters (IVCF) in the management of venous thromboembolism (VTE) is not well defined. The purpose of this study was to compare mortality risk for VTE patients treated with IVCF or anticoagulants.


METHODS
Analyses were based on data from 175 VTE patients, who had concurrent conditions of central nervous system (CNS) cancer or brain hemorrhage, and who were seen at Thomas Jefferson University Hospital between 1998 and 2002. Patients who received filters (n = 136) and those who were treated with anticoagulants only (n = 39) were compared on in-hospital mortality via logistic regression and on overall mortality via survival analyses methods.


RESULTS
A total of 17 study patients (9.7%) died in-hospital. After controlling for patient sociodemographic, medical, and treatment characteristics, the filter group had a 65% reduction of risk compared to the anticoagulant group (adjusted odds ratio, OR = 0.36, P = 0.138). Age, renal disease, and ventriculoperitoneal shunt/ventriculostomy were independent predictors of higher in-hospital mortality. A total of 128 deaths (73.1%) were recorded during the study's entire follow-up period. Unadjusted median survival was 21 weeks for the filter group and 11 weeks for the anticoagulant group (P = 0.177). In adjusted analyses, the filter group had a 28% reduction of risk compared to the anticoagulant group (adjusted hazard ratio, HR = 0.72, P = 0.181). Caucasian race and CNS cancer were independent predictors of higher overall mortality.


CONCLUSIONS
Neither in-hospital nor overall mortality differences between the two treatment groups was significant, although we found some indication of a beneficial effect of filter placement with respect to short-term, in-hospital survival.
Ghanim
Amanda J
AJ
Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, 1170 Main Building, 132 S. 10th St., Philadelphia, PA 19107, USA.
Daskalakis
Constantine
C
Eschelman
David J
DJ
Kraft
Walter K
WK
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects*; D001932:Brain Neoplasms / Q000150:complications / Q000628:therapy; D002543:Cerebral Hemorrhage / Q000188:drug therapy / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D015143:Philadelphia / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D016306:Vena Cava Filters / Q000009:adverse effects*; D054556:Venous Thromboembolism / Q000188:drug therapy / Q000401:mortality*; D020246:Venous Thrombosis / Q000188:drug therapy / Q000401:mortality
D000925:Anticoagulants