Inferior vena cava filters in patients with cancer and venous thromboembolism (VTE) does not improve clinical outcomes: A population-based study.
BACKGROUND
There are few studies that have determined clinical outcomes following inferior vena cava filter (IVCF) insertion in cancer patients hospitalized for acute deep-vein-thrombosis (DVT) or pulmonary embolism (PE).


RESULTS
We analyzed hospital discharge records of all patients with active cancer who were admitted to a California hospital specifically for acute DVT or PE between 2005 through 2009. Propensity and competing risk methodology were used to determine if IVCF-use lowered either 30-day mortality or the risk of recurrent PE, DVT, and major bleeding within 180days. Among 14,000 patients, an IVCF was placed in 2747 (19.6%), but only 577 (21%) of these IVCF patients had an apparent indication for filter use because of acute bleeding or undergoing major surgery. Data on anticoagulation use was not available. Filter-use provided no reduction in either 30-day mortality (HR=1.12, 95% CI: 0.99-1.26, p=0.08) or the adjusted 180-day risk of subsequent PE (±DVT) (HR=0.81, 95% CI: 0.52-1.27, p=0.36). Filter use was, however, associated with an increase in the adjusted180-day risk of recurrent DVT (HR=2.10, 95% CI: 1.53-2.89, p<0.0001).


CONCLUSIONS
We conclude that in this population-based study, approximately 20% of cancer patients with acute VTE received an IVCF, but only 21% of these had an indication for IVCF use. Overall, IVCF use provided neither a short-term survival benefit nor a reduction in risk of recurrent PE, but IVCF use was associated with a higher risk of recurrent DVT.
Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology Oncology, UC Davis School of Medicine, United States.
Ann
A
Brunson
Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology Oncology, UC Davis School of Medicine, United States.
Gwendolyn
G
Ho
Division of General Internal Medicine, UC Davis School of Medicine, United States.
Richard
R
White
Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology Oncology, UC Davis School of Medicine, United States; UC Davis Clinical and Translational Sciences Center, United States; Division of Hematology Oncology, VA Northern California Healthcare System, United States. Electronic address: twun@ucdavis.edu.
Ted
T
Wun
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D057216:Propensity Score; D011655:Pulmonary Embolism / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D016306:Vena Cava Filters / Q000009:adverse effects; D054556:Venous Thromboembolism / Q000209:etiology / Q000401:mortality / Q000628:therapy; D020246:Venous Thrombosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*
Cancer; Epidemiology; Inferior vena cava filter; Pulmonary embolism; Thrombosis