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Original Investigation
April 28, 2015

Effect of a Retrievable Inferior Vena Cava Filter Plus Anticoagulation vs Anticoagulation Alone on Risk of Recurrent Pulmonary Embolism: A Randomized Clinical Trial

Author Affiliations
  • 1Service de Médecine Vasculaire et Thérapeutique, Centre Hospitalier Universitaire de Saint-Etienne, France
  • 2Université Jean Monnet, Groupe d’Investigation et de Recherche Clinique sur la Thrombose, Saint-Etienne, France
  • 3Unité de Pharmacologie Clinique, Centre Hospitalier Universitaire de Saint-Etienne, France
  • 4Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité, France
  • 5Service de Radiologie Interventionnelle, Hôpital Européen Georges Pompidou, Assistance Publique—Hôpitaux de Paris, France
  • 6Département de Cardiologie, Centre Hospitalier Universitaire de Grenoble, La Tronche, France
  • 7Département de Médecine Interne et Pneumologie, Hôpital La Cavale Blanche, Université De Bretagne occidentale, Brest, France
  • 8Service de Médecine Vasculaire et Médecine Interne, Pôle Cardiologie-Vasculaire, Hôpital Sainte Musse, Centre Hospitalier Intercommunal Toulon La Seyne sur Mer, France
  • 9Département de Pathologie Vasculaire, Centre Hospitalier Universitaire Dijon Bocage, France
  • 10Département de Cardiologie, Centre Hospitalier Régional Universitaire Hôpital Jean Minjoz, Besançon, France
  • 11Service de Médecine Vasculaire, Centre Hospitalier Universitaire de Montpellier, Université de Montpellier I, France
  • 12Cardioprotection, Remodelage, et Thrombose and Service des Urgences, Centre Hospitalier Universitaire d'Angers, France
  • 13Université Nantes Angers Le Mans, France
  • 14Service de Pneumologie, Hôpital Européen Georges Pompidou, Université Paris Descartes, Sorbonne Paris Cité, France
  • 15Pôle Urgences, Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand, France
  • 16Université 1 d'Auvergne, Clermont Ferrand, France
  • 17Service de Médecine Vasculaire, Centre Hospitalier Universitaire de Grenoble, France
  • 18Service de Médecine Vasculaire, Centre Hospitalier Universitaire d'Amiens, France
  • 19Service de Radiologie, Hôpital Cardiologique, Centre Hospitalier Universitaire de Lille, France
  • 20Centre Hospitalier Universitaire de Saint-Etienne, Hôpital Nord, Service Médecine d’Urgences et Réanimation, France
  • 21Université de Lyon, Université de Saint-Etienne, France
  • 22Service de Médecine Vasculaire, Centre Hospitalier Universitaire de Limoges, France
  • 23Unité Mixte de Recherche/Centre National de la Recherche Scientifique, University of Lyon, France
  • 24Centre Hospitalier Universitaire de Saint-Etienne, Hôpital Nord, Service Médecine Vasculaire et Thérapeutique, France
  • 25Service de Radiologie, Centre Hospitalier Universitaire de Saint-Etienne, France
  • 26Université Jean Monnet, Saint-Etienne, France
JAMA. 2015;313(16):1627-1635. doi:10.1001/jama.2015.3780
Abstract

Importance  Although retrievable inferior vena cava filters are frequently used in addition to anticoagulation in patients with acute venous thromboembolism, their benefit-risk ratio is unclear.

Objective  To evaluate the efficacy and safety of retrievable vena cava filters plus anticoagulation vs anticoagulation alone for preventing pulmonary embolism recurrence in patients presenting with acute pulmonary embolism and a high risk of recurrence.

Design, Setting, and Participants  Randomized, open-label, blinded end point trial (PREPIC2) with 6-month follow-up conducted from August 2006 to January 2013. Hospitalized patients with acute, symptomatic pulmonary embolism associated with lower-limb vein thrombosis and at least 1 criterion for severity were assigned to retrievable inferior vena cava filter implantation plus anticoagulation (filter group; n = 200) or anticoagulation alone with no filter implantation (control group; n = 199). Initial hospitalization with ambulatory follow-up occurred in 17 French centers.

Interventions  Full-dose anticoagulation for at least 6 months in all patients. Insertion of a retrievable inferior vena cava filter in patients randomized to the filter group. Filter retrieval was planned at 3 months from placement.

Main Outcomes and Measures  Primary efficacy outcome was symptomatic recurrent pulmonary embolism at 3 months. Secondary outcomes were recurrent pulmonary embolism at 6 months, symptomatic deep vein thrombosis, major bleeding, death at 3 and 6 months, and filter complications.

Results  In the filter group, the filter was successfully inserted in 193 patients and was retrieved as planned in 153 of the 164 patients in whom retrieval was attempted. By 3 months, recurrent pulmonary embolism had occurred in 6 patients (3.0%; all fatal) in the filter group and in 3 patients (1.5%; 2 fatal) in the control group (relative risk with filter, 2.00 [95% CI, 0.51-7.89]; P = .50). Results were similar at 6 months. No difference was observed between the 2 groups regarding the other outcomes. Filter thrombosis occurred in 3 patients.

Conclusions and Relevance  Among hospitalized patients with severe acute pulmonary embolism, the use of a retrievable inferior vena cava filter plus anticoagulation compared with anticoagulation alone did not reduce the risk of symptomatic recurrent pulmonary embolism at 3 months. These findings do not support the use of this type of filter in patients who can be treated with anticoagulation.

Trial Registration  clinicaltrials.gov Identifier: NCT00457158

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