Outcomes after Vena Cava Filter Use in Patients with Cancer-Associated Venous Thromboembolism and Contraindications to Anticoagulation

Andrés Quezada; David Jiménez; Behnood Bikdeli; Alfonso Muriel; Mario Aramberri; Luciano López-Jiménez; Joan Carles Sahuquillo; Remedios Otero; Angelo Porfidia; Manuel Monreal; the RIETE Investigators

doi:10.1055/s-0040-1710589

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2020; 120(07): 1035-1044
DOI: 10.1055/s-0040-1710589

Coagulation and Fibrinolysis

Georg Thieme Verlag KG Stuttgart · New York

Outcomes after Vena Cava Filter Use in Patients with Cancer-Associated Venous Thromboembolism and Contraindications to Anticoagulation

Andrés Quezada‡^*

¹Department of Respiratory Medicine, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain

,

David Jiménez^*

¹Department of Respiratory Medicine, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain

,

Behnood Bikdeli

²Division of Cardiology, Department of Medicine, Columbia University Medical Center, NewYork-Presbyterian Hospital, New York, United States

³Center for Outcomes Research and Evaluation (CORE), Yale University School of Medicine, New Haven, Connecticut, United States

⁴Cardiovascular Research Foundation (CRF), New York, New York, United States

,

Alfonso Muriel‡^*

⁵Biostatistics Unit, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, CIBERESP, Madrid, Spain

,

Mario Aramberri

⁶Department of Medicine, Hospital Doce de Octubre, Madrid, Spain

,

Luciano López-Jiménez

⁷Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain

,

Joan Carles Sahuquillo

⁸Department of Internal Medicine, Hospital Municipal de Badalona, Barcelona, Spain

,

Remedios Otero

⁹Department of Pneumonology, Hospital Universitario Virgen del Rocío, Seville, Spain

,

Angelo Porfidia

¹⁰Department of Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

,

Manuel Monreal

¹¹Department of Internal Medicine, Hospital Germans Trias i Pujol, Universidad Católica de Murcia, Badalona, Barcelona, Spain

,

the RIETE Investigators

› Institutsangaben

Abstract

Background The association between the use of inferior vena cava filters (IVCFs) and outcomes among patients with cancer-associated thromboembolism (CT) and contraindications to anticoagulation remains unclear.

Methods In this prospective cohort study of patients with CT from the Registro Informatizado de la Enfermedad TromboEmbólica Registry, we assessed the association between IVCF insertion due to contraindication to anticoagulation and the outcomes of all-cause mortality, pulmonary embolism (PE)-related mortality, recurrent thromboembolism, and major bleeding rates through 30 days after initiation of treatment. We used propensity score matching to adjust for the likelihood of receiving a filter. For outcomes assessment, we implemented generalized estimating equation methods to incorporate the matched-pairs design, and adjusted for covariates that remained unbalanced after matching.

Results Of the 17,005 patients with CT, 270 underwent IVCF placement because of contraindication to anticoagulation. Of those, 247 were successfully matched with 247 patients treated without a filter. Propensity score-matched pairs showed a nonsignificantly lower risk of all-cause death (12.2% vs. 17.0%; p = 0.13), and a significantly lower risk of PE-related mortality (0.8% vs. 4.0%; p = 0.04) for patients receiving IVCFs compared with those who did not. While there was no significant difference in the rate of major bleeding (6.1% vs. 5.7%; p = 0.85), risk-adjusted recurrent rates were higher for patients who received IVCFs compared with those who did not (7.3% vs. 3.2%; p = 0.05).

Conclusion In patients with CT and a contraindication to anticoagulation, IVCF insertion was associated with a lower risk of PE-related death, and a higher risk of recurrences.

Keywords

cancer-associated thrombosis - vena cava filter - survival - prognosis - pulmonary embolism

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Referenzen

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