title: Anticoagulation Is Associated with Decreased Inferior Vena Cava Filter-Related Complications in Patients with Metastatic Carcinoma.
abstract: OBJECTIVE
  Patients with metastatic carcinoma and venous thromboembolism commonly have contraindications to anticoagulation that prompt the use of retrievable inferior vena cava filters. The aim of this study was to compare the pattern of inferior vena cava filter use, anticoagulation management, and development of inferior vena cava filter-related complications in patients with localized versus metastatic carcinoma.
  
  
  METHODS
  We conducted a retrospective cohort study of inferior vena cava filter use at a tertiary referral hospital between January 1, 2009, and December 31, 2011. Including only patients with cancer and carcinomas, both metastatic and localized, we recorded the indications for inferior vena cava filter, postfilter practices including anticoagulation use, filter retrieval rates, and filter-related complications.
  
  
  RESULTS
  Overall, 154 patients with carcinoma underwent inferior vena cava filter placement. Basic demographics and indication for filter placement were similar between the metastatic and localized groups. Metastatic patients had more filter-related complications (25% vs 11%, P = .03) and underwent filter retrieval less often (31% vs 58%, P = .01). Time to reinitiating anticoagulation was longer in metastatic patients (5.5 vs 2 days, P = .05). In multivariate analysis, metastatic disease was associated with reduced inferior vena cava filter retrieval (odds ratio, 0.3; P = .003). Anticoagulation use was associated with a lower rate of filter-related complications (odds ratio, 0.3; P = .005).
  
  
  CONCLUSIONS
  Patients with metastatic carcinoma with an indwelling inferior vena cava filter had a higher rate of filter-related complications, a lower filter retrieval rate, and a greater median time to initiating anticoagulation. When possible, early reinitiation of anticoagulation may reduce inferior vena cava filter-related complications.
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston; Cardiology Division, Brigham and Women's Hospital, Boston, Mass.
authors.forename: Syed S
authors.initials: SS
authors.lastname: Mahmood
authors.affiliation: Cardiology, Rochester Regional Health Center, NY.
authors.forename: Farhad
authors.initials: F
authors.lastname: Abtahian
authors.affiliation: Department of Hematology and Oncology, Massachusetts General Hospital, Boston.
authors.forename: Annemarie E
authors.initials: AE
authors.lastname: Fogerty
authors.affiliation: Department of Medicine and Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston.
authors.forename: Philip
authors.initials: P
authors.lastname: Cefalo
authors.affiliation: Fireman Vascular Center, Massachusetts General Hospital, Boston.
authors.forename: Cheryl
authors.initials: C
authors.lastname: MacKay
authors.affiliation: Fireman Vascular Center, Massachusetts General Hospital, Boston.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Jaff
authors.affiliation: Fireman Vascular Center, Massachusetts General Hospital, Boston. Electronic address: iweinberg@mgh.harvard.edu.
authors.forename: Ido
authors.initials: I
authors.lastname: Weinberg
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009369:Neoplasms / Q000150:complications*; D012189:Retrospective Studies; D016306:Vena Cava Filters / Q000009:adverse effects*; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control
chemical_list: D000925:Anticoagulants
keywords: Anticoagulants; Carcinoma; Inferior vena cava filters; Metastatic cancer; Venous thromboembolism