Andrés Quezada1, David Jiménez1, Behnood Bikdeli2,3,4, Alfonso Muriel5, Mario Aramberri6, Luciano López-Jiménez7, Joan Carles Sahuquillo8, Remedios Otero9, Angelo Porfidia10, Manuel Monreal11. 1. Department of Respiratory Medicine, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain. 2. Division of Cardiology, Department of Medicine, Columbia University Medical Center, NewYork-Presbyterian Hospital, New York, United States. 3. Center for Outcomes Research and Evaluation (CORE), Yale University School of Medicine, New Haven, Connecticut, United States. 4. Cardiovascular Research Foundation (CRF), New York, New York, United States. 5. Biostatistics Unit, Ramón y Cajal Hospital and Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, CIBERESP, Madrid, Spain. 6. Department of Medicine, Hospital Doce de Octubre, Madrid, Spain. 7. Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain. 8. Department of Internal Medicine, Hospital Municipal de Badalona, Barcelona, Spain. 9. Department of Pneumonology, Hospital Universitario Virgen del Rocío, Seville, Spain. 10. Department of Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. 11. Department of Internal Medicine, Hospital Germans Trias i Pujol, Universidad Católica de Murcia, Badalona, Barcelona, Spain.
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. Georg Thieme Verlag KG Stuttgart · New York.
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. Georg Thieme Verlag KG Stuttgart · New York.
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