Association of Inferior Vena Cava Filter Placement With Rates of Pulmonary Embolism in Patients With Cancer and Acute Lower Extremity Deep Venous Thrombosis
| Autor: | Steven Yevich, Rahul A. Sheth, J. Kuban, Alda L. Tam, Steven Y. Huang, Sanjay Gupta, Sunil A Sheth, Stephen R. Lee, Zeyad A. Metwalli, Colin J. McCarthy, Samyuktha Balabhadra |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Vena Cava Filters Patients Adolescent Population Inferior vena cava filter Inferior vena cava California Cohort Studies Risk Factors Neoplasms medicine Odds Ratio Humans cardiovascular diseases education Child Original Investigation Aged Aged 80 and over Venous Thrombosis education.field_of_study business.industry Research Hazard ratio Infant General Medicine Odds ratio Middle Aged medicine.disease Surgery Pulmonary embolism Venous thrombosis Online Only Treatment Outcome medicine.vein Oncology Lower Extremity Child Preschool cardiovascular system Female business Pulmonary Embolism Cohort study |
| Zdroj: | JAMA Network Open |
| ISSN: | 2574-3805 |
| Popis: | Key Points 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. 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 This cohort study evaluates the association of inferior vena cava (IVC) filters with the development of pulmonary embolism (PE) in patients with cancer and deep venous thrombosis (DVT). |
| Databáze: | OpenAIRE |
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