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

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

Authors' Contributions

Study concept and design: A.Q., D.J., M.M. Acquisition of data; analysis and interpretation of data; statistical analysis: A.Q., D.J., B.B., A.M., M.A., L.L.-J., J.C.S., R.O., A.P., M.M. Drafting of the manuscript: A.Q., D.J., B.B., M.A., M.M. Critical revision of the manuscript for important intellectual content: A.Q., D.J., B.B., A.M., M.A., L.L.-J., J.C.S., R.O., A.P., M.M. Study supervision: D.J., M.M. The corresponding author, David Jiménez, had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Members of the RIETE Registry

Coordinator of the RIETE Registry: Manuel Monreal.

RIETE Steering Committee Members: Paolo Prandoni, Benjamin Brenner and Dominique Farge-Bancel.

RIETE National Coordinators: Raquel Barba (Spain), Pierpaolo Di Micco (Italy), Laurent Bertoletti (France), Sebastian Schellong (Germany), Inna Tzoran (Israel), Abilio Reis (Portugal), Marijan Bosevski (R. Macedonia), Henri Bounameaux (Switzerland), Radovan Malý (Czech Republic), Peter Verhamme (Belgium), Joseph A. Caprini (USA), Hanh My Bui (Vietnam).

RIETE Registry Coordinating Center: S & H Medical Science Service.

Members of the RIETE Group

Spain: Adarraga MD, Agud M, Aibar MA, Alfonso J, Amado C, Arcelus JI, Ballaz A, Barba R, Barbagelata C, Barrón M, Barrón-Andrés B, Blanco-Molina A, Camon AM, Cañas I, Castro J, de Miguel J, del Toro J, Demelo P, Díaz-Peromingo JA, Díaz-Simón R, Escribano JC, Falgá C, Fernández-Capitán C, Fernández-Criado MC, Fernández de Roitegui K, Fidalgo MA, Flores K, Font C, Font L, Furest I, García MA, García-Bragado F, García-Raso A, Gavín-Blanco O, Gavín-Sebastián O, Gaya-Manso I, Gil-Díaz A, Gómez V, Gómez-Cuervo C, González-Martínez J, Grau E, Guirado L, Gutiérrez J, Hernández-Blasco LM, Jara-Palomares L, Jaras MJ, Jiménez D, Joya MD, Jou I, Lacruz B, Lecumberri R, Lima J, Llamas P, Lobo JL, López-Jiménez L, López-Meseguer M, López-Miguel P, Lalueza A, López-Núñez JJ, López-Reyes R, López-Sáez JB, Lorente MA, Loring M, Lumbierres M, Madridano O, Maestre A, Manrique-Abos I, Marchena PJ, Martín-Fernández M, Martín-Martos F, Mellado M, Moisés J, Monreal M, Morales MV, Muñoz D, Nieto JA, Núñez MJ, Olivares MC, Olivera PE, Osorio J, Otalora S, Otero R, Pedrajas JM, Pellejero G, Pérez-Ductor C, Pérez-Rus G, Peris ML, Pesantez D, Pesce ML, Porras JA, Riera-Mestre A, Rivas A, Rodríguez-Cobo A, Rodríguez-Galán I, Rodríguez-Matute C, Rosa V, Rubio CM, Ruiz-Artacho P, Ruiz-Sada P, Sanoja ID, Sahuquillo JC, Sala-Sainz MC, Salgueiro G, Sampériz A, Sánchez-Muñoz-Torrero JF, Soler S, Suárez S, Suriñach JM, Tolosa C, Torres MI, Trujillo-Santos J, Uresandi F, Usandizaga E, Valle R, Vidal G, Villares P. Argentina: Gutiérrez P, Vázquez FJ. Belgium: Vanassche T, Vandenbriele C, Verhamme P. Czech Republic: Hirmerova J, Malý R. Ecuador: Salgado E. France: Benzidia I, Bertoletti L, Bura-Riviere A, Debourdeau P, Courtois MC, Farge-Bancel D, Helfer H, Hij A, Mahé I, Moustafa F. Germany: Schellong S. Israel: Braester A, Brenner B, Tzoran I. Italy: Barillari A, Barillari G, Bilora F, Bortoluzzi C, Brandolin B, Ciammaichella M, Dentali F, Di Micco P, Ferrazzi P, Imbalzano E, Landolfi R, Lodigiani C, Maida R, Pace F, Parisi R, Pesavento R, Porfidia A, Prandoni P, Quintavalla R, Rocci A, Rota L, Siniscalchi C, Tiraferri E, Tufano A, Visonà A, Vo Hong N, Zalunardo B. Latvia: Kigitovica D, Meilande K, Skride A. Republic of Macedonia: Bosevski M, Zdraveska M. Switzerland: Bounameaux H, Fresa M, Mazzolai L, Ney B. USA: Bikdeli B, Caprini J, Tafur AJ. Vietnam: Bui HM.

^* These authors contributed equally to the manuscript.

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