Ann Brunson1, Gwendolyn Ho1, Richard White2, Ted Wun3. 1. Center for Oncology Hematology Outcomes Research and Training (COHORT), Division of Hematology Oncology, UC Davis School of Medicine, United States. 2. Division of General Internal Medicine, UC Davis School of Medicine, United States. 3. 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.
Abstract
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). METHODS AND 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. Published by Elsevier Ltd.
BACKGROUND: There are few studies that have determined clinical outcomes following inferior vena cava filter (IVCF) insertion in cancerpatients hospitalized for acute deep-vein-thrombosis (DVT) or pulmonary embolism (PE). METHODS AND 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 cancerpatients 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. Published by Elsevier Ltd.
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