title: Survival effects of inferior vena cava filter in patients with acute symptomatic venous thromboembolism and a significant bleeding risk.
abstract: OBJECTIVE
  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.
authors.affiliation: Biostatistics Unit, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, CIBERESP, Madrid, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Muriel
authors.affiliation: Respiratory Department, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Madrid, Spain. Electronic address: djc_69_98@yahoo.com.
authors.forename: David
authors.initials: D
authors.lastname: Jiménez
authors.affiliation: Division of General Internal Medicine, Bern University Hospital, Bern, Switzerland.
authors.forename: Drahomir
authors.initials: D
authors.lastname: Aujesky
authors.affiliation: Thrombosis Research Group, Université de Saint-Etienne, Jean Monnet, Inserm, Service de Médecine Interne et Thérapeutique, Hôpital Nord, Saint-Etienne, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Bertoletti
authors.affiliation: Thrombosis Research Group, Université de Saint-Etienne, Jean Monnet, Inserm, Service de Médecine Interne et Thérapeutique, Hôpital Nord, Saint-Etienne, France.
authors.forename: Herve
authors.initials: H
authors.lastname: Decousus
authors.affiliation: Thrombosis Research Group, Université de Saint-Etienne, Jean Monnet, Inserm, Service de Médecine Interne et Thérapeutique, Hôpital Nord, Saint-Etienne, France.
authors.forename: Silvy
authors.initials: S
authors.lastname: Laporte
authors.affiliation: Thrombosis Research Group, Université de Saint-Etienne, Jean Monnet, Inserm, Service de Médecine Interne et Thérapeutique, Hôpital Nord, Saint-Etienne, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Mismetti
authors.affiliation: Department of Internal Medicine, Hospital de Mollet, Barcelona, Spain.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Muñoz
authors.affiliation: Divisions of Pulmonary and Critical Care Medicine and General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Roger
authors.initials: R
authors.lastname: Yusen
authors.affiliation: Department of Internal Medicine, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Monreal
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D016306:Vena Cava Filters; D054556:Venous Thromboembolism / Q000401:mortality / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants
keywords: deep vein thrombosis; prognosis; pulmonary embolism; survival; vena cava filter; venous thromboembolism