Vena cava filters in hospitalised patients with chronic obstructive pulmonary disease and pulmonary embolism

Paul D. Stein; Fadi Matta

doi:10.1160/TH13-01-0006

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2013; 109(05): 897-900
DOI: 10.1160/TH13-01-0006

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Vena cava filters in hospitalised patients with chronic obstructive pulmonary disease and pulmonary embolism

Authors

Paul D. Stein

¹Department of Osteopathic Medical Specialties, Michigan State University College of Osteopathic Medicine, East Lansing, Michigan, USA
Fadi Matta

¹Department of Osteopathic Medical Specialties, Michigan State University College of Osteopathic Medicine, East Lansing, Michigan, USA

²Department of Research, St. Mary Mercy Hospital, Livonia, Michigan, USA

Abstract

Summary

In view of the high case fatality rates of patients with chronic obstructive pulmonary disease (COPD) who have pulmonary embolism (PE) we speculated that such patients might benefit from vena cava filters. To test this hypothesis we assessed the database of the Nationwide Inpatient Sample. From 1998–2009, 440,370 patients were hospitalised with PE and COPD who were not in shock or ventilator-dependent and did not receive thrombolytic therapy or pulmonary embolectomy. In-hospital all-cause case fatality rate among those with filters was 5,890 of 68,800 (8.6%) (95% confidence interval [CI] = 8.4–8.8) compared with 38,960 of 371,570 (10.5%) (95% CI = 10.4–10.6) (p<0.0001) who did not receive filters. Case fatality rate was age-dependent. Only those who were older than aged 50 years had a lower in-hospital all-cause case fatality rate with filters. Among such patients, absolute risk reduction was 2.1% (95% CI = 1.9–2.3). The greatest reduction of case fatality rate with vena cava filters was shown in patients >aged 80 years, 11,720 of 81,600 (14.4%) compared with 1,570 of 17,220 (9.1%) (p<0.0001). In conclusion, a somewhat lower in-hospital all-cause case fatality rate was shown with vena filters in stable patients with PE >aged 50 years who also had COPD. The benefit was greatest in elderly patients. The benefit in terms of a decreased case fatality rate would seem to outweigh the risks of vena cava filters in such patients.

Keywords

Pulmonary embolism - venous thromboembolism - vena cava filters - chronic obstructive pulmonary disease

Full Text

References

References
1 Piazza G, Goldhaber SZ, Kroll A. et al. Venous thromboembolism in patients with chronic obstructive pulmonary disease. Am J Med 2012; 125: 1010-1018.
2 Monreal M, Muñoz-Torrero JF, Naraine VS. et al. RIETE Investigators Pulmonary embolism in patients with chronic obstructive pulmonary disease or congestive heart failure. Am J Med 2006; 119: 851-858.
3 Stein PD, Matta F, Keyes DC. et al. Impact of vena cava filters on in-hospital case fatality rates from pulmonary embolism. Am J Med 2012; 125: 478-484.
4 HCUP Nationwide Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP). 1998-2009. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/nisoverview.jsp
5 Stein PD, Matta F. Case fatality rate with pulmonary embolectomy for acute pulmonary embolism. Am J Med 2012; 125: 471-477.
6 Athanasoulis CA, Kaufman JA, Halpern EF. et al. Inferior vena caval filters: Review of a 26-year single-center clinical experience. Radiology 2000; 216: 54-66.
7 Bergqvist D. The role of vena caval interruption in patients with venous thromboembolism. Prog in Cardiov Dis 1994; 37: 25-37.
8 Decousus H, Leizorovicz A, Parent F. et al. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis Prévention du Risque d’Embolie Pulmonaire par Interruption Cave Study Group. N Engl J Med 1998; 338: 409-415.
9 PREPIC Study Group. Eight-year follow-up of patients with permanent vena cava filters in the prevention of pulmonary embolism: the PREPIC (Prevention du Risque d’Embolie Pulmonaire par Interruption Cave) randomized study. Circulation 2005; 112: 416-422.
10 Young T, Tang H, Hughes R. Vena caval filters for the prevention of pulmonary embolism. Cochrane Database Syst Rev. 2010: CD006212.
11 Fullen WD, Miller EH, Steele WF. et al. Prophylactic vena caval interruption in hip fractures. J Trauma 1973; 13: 403-410.
12 Janjua M, Younas F, Moinuddin I. et al. Outcome with inferior vena cava filters. J Invas Cardiol 2010; 22: 235-239.
13 Stein PD, Alnas M, Skaf E. et al. Outcome and complications of retrievable inferior vena cava filters. Am J Cardiol 2004; 94: 1090-1093.
14 Imberti D, Ageno W, Dentali F. et al. Retrievable vena cava filters: a clinical review. J Thromb Thrombolysis 2012; 33: 258-266.
15 Severinsen MT, Kristensen SR, Overvad K D. et al. Venous thromboembolism discharge diagnoses in the Danish National Patient Registry should be used with caution. J Clin Epidemiol 2010; 63: 223-228.
16 Kniffin Jr. WD, Baron JA, Barrett J. et al. The epidemiology of diagnosed pulmonary embolism and deep venous thrombosis in the elderly. Arch Intern Med 1994; 154: 861-866.
17 Kearon C, Akl EA, Comerota AJ. et al. Antithrombotic therapy for VTE disease: antithrombotic therapy for prevention of thrombosis, 9th Ed. American College of Chest Physicians Evidence-Based Guidelines. Chest. 2012; 141 Suppl e419S-e494S.