title: Outcomes After Vena Cava Filter Use in Noncancer Patients With Acute Venous Thromboembolism: A Population-Based Study.
abstract: Evidence that vena cava filters (VCFs) are beneficial is limited.
  
  
  
  We retrospectively analyzed all noncancer patients admitted to nonfederal California hospitals for acute venous thromboembolism from 2005 to 2010. Analysis was stratified by the presence/absence of a contraindication to anticoagulation (active bleeding, major surgery). Outcomes were death within 30 or 90 days of admission and the 1-year incidence of recurrent venous thromboembolism manifested as pulmonary embolism or deep vein thrombosis. Propensity score methods were used to account for observed systematic differences in baseline characteristics between patients treated and those not treated with a VCF. Among 80 697 patients with no contraindication to anticoagulation, VCF use (n=7762, 9.6%) did not significantly reduce the 30-day risk of death (hazard ratio [HR], 1.12; 95% confidence interval [CI], 0.98-1.28). Among 3017 patients with active bleeding, VCF use (n=1095, 36.3%) reduced the 30-day risk of death by 32% (HR, 0.68; 95% CI, 0.52-0.88) and the 90-day risk by 27% (HR, 0.73; 95% CI, 0.59-0.90). VCF use (n=489, 33.8%) did not reduce mortality among 1445 patients who underwent major surgery (HR, 1.1; 95% CI, 0.71-1.77). In all subgroups, filter use did not reduce the risk of subsequent pulmonary embolism. However, the risk of subsequent deep vein thrombosis increased by 50% among VCF patients with no contraindication (HR, 1.53; 95% CI, 1.34-1.74) and by 135% among VCF patients with active bleeding (HR, 2.35; 95% CI, 1.56-3.52).
  
  
  
  VCF use significantly reduced the short-term risk of death only among patients with acute venous thromboembolism who had a contraindication to anticoagulation because of active bleeding. These results support the findings of a randomized clinical trial and current guidelines that recommend VCF use only in patients who cannot receive anticoagulation treatment.
authors.affiliation: From Division of General Internal Medicine (R.H.W., P.S.R., Z.L.) and Division of Hematology Oncology (A.B., T.W.), Department of Medicine, University of California, Davis School of Medicine, Sacramento. rhwhite@ucdavis.edu.
authors.forename: Richard H
authors.initials: RH
authors.lastname: White
authors.affiliation: From Division of General Internal Medicine (R.H.W., P.S.R., Z.L.) and Division of Hematology Oncology (A.B., T.W.), Department of Medicine, University of California, Davis School of Medicine, Sacramento.
authors.forename: Ann
authors.initials: A
authors.lastname: Brunson
authors.affiliation: From Division of General Internal Medicine (R.H.W., P.S.R., Z.L.) and Division of Hematology Oncology (A.B., T.W.), Department of Medicine, University of California, Davis School of Medicine, Sacramento.
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Romano
authors.affiliation: From Division of General Internal Medicine (R.H.W., P.S.R., Z.L.) and Division of Hematology Oncology (A.B., T.W.), Department of Medicine, University of California, Davis School of Medicine, Sacramento.
authors.forename: Zhongmin
authors.initials: Z
authors.lastname: Li
authors.affiliation: From Division of General Internal Medicine (R.H.W., P.S.R., Z.L.) and Division of Hematology Oncology (A.B., T.W.), Department of Medicine, University of California, Davis School of Medicine, Sacramento.
authors.forename: Ted
authors.initials: T
authors.lastname: Wun
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009369:Neoplasms; D011159:Population Surveillance; D012189:Retrospective Studies; D016896:Treatment Outcome; D016306:Vena Cava Filters / Q000706:statistics & numerical data*; D054556:Venous Thromboembolism / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*
keywords: epidemiology; pulmonary embolism; thrombosis; venous thromboembolism