title: Impact of Anticoagulation in Elderly Patients With Pulmonary Embolism That Undergo IVC Filter Placement: A Retrospective Cohort Study.
abstract: BACKGROUND
  Anticoagulation is the primary treatment for pulmonary embolism (PE). Inferior vena cava (IVC) filters are an adjunctive intervention to prevent recurrent pulmonary embolism. Long-term outcomes in elderly patients with contraindications to anticoagulation after IVC filter placement for prevention of recurrent pulmonary embolism have yet to be assessed.
  
  
  METHODS
  Patients ≥60years of age, that had an IVC filter placed between 1 January, 2008 and 2 February, 2013, with a primary diagnosis of pulmonary embolism, were included. Patients that died during index hospitalisation, were discharged to hospice, or had active malignancy were excluded. The primary endpoint was overall survival. Patients were divided depending on whether they were treated with an approved anticoagulant for VTE or had no anticoagulant.
  
  
  RESULTS
  Of the 152 patients identified, 55 were not anti-coagulated after IVC filter placement. The incidence of death was 0.4 per 1000 filter days and 0.7 per 1000 filter days in the anti-coagulated and untreated groups respectively (p-value=0.06). After statistical correction for co-morbid conditions, the effect of anticoagulation was not significant (HR 0.82 CI 0.49-1.37, p-value 0.46). Age was a significant confounder that was associated with death. Increased BMI was protective. Indications for IVC filter placement were numerous, but similar between the two groups.
  
  
  CONCLUSIONS
  Treatment with an approved anticoagulant is recommended after IVC filter placement for prevention of recurrent PE, however its effect may be attenuated by advanced age. In elderly patients that have undergone IVC filter placement for prevention of recurrent PE, survival may be more dependent on age and co-morbid conditions than exposure to anticoagulation.
authors.affiliation: Critical Care/Pulmonary Medicine, Beaumont Health System, Detroit, MI, USA; Outcomes Research, Beaumont Research Institute, Detroit, MI, USA. Electronic address: john.falatko@beaumont.edu.
authors.forename: John M
authors.initials: JM
authors.lastname: Falatko
authors.affiliation: Critical Care/Pulmonary Medicine, Beaumont Health System, Detroit, MI, USA.
authors.forename: Bhavinkumar
authors.initials: B
authors.lastname: Dalal
authors.affiliation: Outcomes Research, Beaumont Research Institute, Detroit, MI, USA.
authors.forename: Lihua
authors.initials: L
authors.lastname: Qu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001777:Blood Coagulation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000097:blood / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D016306:Vena Cava Filters
chemical_list: D000925:Anticoagulants
keywords: Anticoagulant; Elderly; Inferior vena cava filters; Pulmonary embolism; Venous thrombo-embolism