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    Original Investigation
    Oncology
    July 23, 2020

    Association of Inferior Vena Cava Filter Placement With Rates of Pulmonary Embolism in Patients With Cancer and Acute Lower Extremity Deep Venous Thrombosis

    Author Affiliations
    • 1Department of Radiology, University of Texas Health McGovern School of Medicine, Houston
    • 2Department of Interventional Radiology, University of Texas MD Anderson Cancer Center, Houston
    • 3Department of Neurology, UTHealth McGovern School of Medicine, Houston, Texas
    JAMA Netw Open. 2020;3(7):e2011079. doi:10.1001/jamanetworkopen.2020.11079
    Key Points español 中文 (chinese)

    Question  Is placement of an inferior vena cava filter associated with a lower rate of pulmonary embolism in patients with cancer and deep venous thrombosis?

    Findings  In a population-based cohort study of 88 585 patients with cancer and deep venous thrombosis, the use of inferior vena cava filters was associated with a significant decrease in the rate of pulmonary embolism after accounting for venous thromboembolism risk factors and competing risks.

    Meaning  For patients with cancer and deep venous thrombosis, the use of inferior vena cava filters may be warranted.

    Abstract

    Importance  Venous thromboembolism is the second overall leading cause of death for patients with cancer, and there is an approximately 2-fold increase in fatal pulmonary embolism (PE) in patients with cancer. Inferior vena cava (IVC) filters are designed to prevent PE, but defining the appropriate use of IVC filters in patients with cancer remains a substantial unmet clinical need.

    Objective  To evaluate the association of IVC filters with the development of PE in patients with cancer and deep venous thrombosis (DVT).

    Design, Setting, and Participants  A population-based cohort study was conducted using administrative data on 88 585 patients from the state inpatient databases for California (2005-2011) and Florida (2005-2014). Based on diagnostic and procedure codes, patients with cancer and acute lower extremity DVT were identified. All subsequent hospital visits for these patients were evaluated for the placement of an IVC filter, the development of new PE, the development of new DVT, and in-hospital mortality. Data analysis was performed from September 1 to December 1, 2019.

    Exposures  Placement of an IVC filter.

    Main Outcomes and Measures  The association of IVC filter placement with rates of new PE and DVT was estimated using a propensity score matching algorithm and competing risk analysis.

    Results  The study cohort comprised 88 585 patients (45 074 male; median age, 71.0 years [range, 1.0-104.0 years]) with malignant neoplasms who presented to a health care institution with a diagnosis of acute lower extremity DVT. Of these patients, 33 740 (38.1%) underwent IVC filter placement; patients with risk factors such as upper gastrointestinal bleeding (odds ratio, 1.32; 95% CI, 1.29-1.37), intracranial hemorrhage (odds ratio, 1.21; 95% CI, 1.19-1.24), and coagulopathy (odds ratio, 1.09; 95% CI, 1.08-1.10) were more likely to receive an IVC filter. A total of 4492 patients (5.1%) developed a new PE after their initial DVT diagnosis. There was a significant improvement in PE-free survival for these patients compared with those who did not receive IVC filters across the full, unbalanced study cohort as well as after propensity score matching and competing risk analysis (hazard ratio, 0.69; 95% CI, 0.64-0.75; P < .001). Furthermore, IVC filter placement reduced the development of PE in patients with very high-risk malignant neoplasms (eg, pancreaticobiliary cancer), high-risk malignant neoplasms (eg, lung cancer), and low-risk malignant neoplasms (eg, prostate cancer). After accounting for anticoagulation use and imbalanced risk factors, IVC filter placement did not increase the risk of new DVT development.

    Conclusions and Relevance  This study suggests that, for patients with cancer and DVT and bleeding risk factors, IVC filter placement is associated with an increased rate of PE-free survival.

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