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IVC filter therapy may reduce mortality risk in recurrent PE vs. anticoagulation alone
The use of inferior vena cava filter therapy plus anticoagulation may decrease mortality risk vs. anticoagulation alone in patients with recurrent pulmonary embolism, according to recent findings.
However, researchers found no effect of inferior vena cava (IVC) filter use on outcomes in patients with recurrent deep vein thrombosis.
In the propensity-matched retrospective cohort study, researchers evaluated prospectively gathered data on 606 patients with acute symptomatic or asymptomatic recurrent venous thromboembolism (VTE) who were enrolled in the multicenter RIETE registry between 2001 and September 2015. All patients were taking an anticoagulant.
VTE recurrence
Deep vein thrombosis (DVT) recurrence (n = 323) was defined as a new noncompressible vein segment or increase of the vein diameter by at least 4 mm vs. the last available measurement, and PE recurrence (n = 283) was defined as a new ventilation-perfusion incongruity on a lung scan or a new intraluminal filling defect on spiral CT of the chest.
Events occurring within 3 months of the index event were considered recurrences.
The researchers identified only patients who did not have pre-existing IVC filters, did not receive IVC filters for the initial VTE event, and who were on an anticoagulation regimen for the index VTE event.
The primary endpoint was all-cause mortality through 30 days post-VTE recurrence, and secondary endpoints included 30-day PE-related mortality, major bleeding and second VTE recurrence as secondary endpoints. Stratified analyses were conducted by type of recurrence, and researchers used a propensity-score adjustment to compare treatment effects in patients with comparable predicted likelihoods of undergoing IVC filter therapy. The researchers found that, of the 323 patients who had recurrence of DVT, death occurred in 14.3% (95% CI, 3.1-36.3) of those who received IVC filters, and death occurred in 9.6% (95% CI, 6.5-13.5) of those who did not receive filters (P = .44) during follow-up. In the propensity-score matched cohort of those with DVT recurrence (17 with IVC filters, 49 without), 17.7% of the IVC filter group died vs. 12.2% of those without IVC filters (P = .56).
Of the 283 patients with PE recurrence, death occurred in 1.8% (95% CI, 0.1-9.9) of patients inserted with filters and in 26.6% (95% CI, 21-32.9) of patients who did not receive filters (P < .001) during follow-up. The adjusted analysis showed a decrease in the primary outcome for filter insertion vs. no filter insertion (P < .001).
Outcomes improved
The matching of the patients with recurrent PE yielded 48 patients treated with filters and 91 patients without filters. Among these patients, there was a reduction in all-cause mortality after filter insertion vs. no filter (2.1% vs. 25.3%; P = .02). Patients for whom filters were inserted did not have a significantly lower PE-related mortality rate vs. those who did not receive filters (2.1% vs. 17.6%; P = .08), although there was a notable difference in the point estimates.
“IVC filter therapy might reduce the risk for death compared with anticoagulant therapy in patients who experience PE recurrence during the first 3 months of anticoagulant therapy,” the researchers wrote. “However, we did not detect a survival advantage associated with the use of IVC filter therapy in patients who have DVT recurrence while on anticoagulation.” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.