Clinical course of patients with venous thromboembolism and inferior inferior cava vein filter: cohort study

POSADAS-MARTINEZ, MARIA LOURDES; MARIA GRANDE-RATTI; PAULA GUTIÉRREZ; FERNAN QUIROS; DIEGO GIUNTA; FERNANDO VAZQUEZ

THROMBOSIS RESEARCH

PERGAMON-ELSEVIER SCIENCE LTD

Lugar: Amsterdam; Año: 2016 vol. 141

0049-3848

Background: Despite the current growing use of inferior vena cava filtersin patients with venous thromboembolism (VTE), there is little data onthe evolution of these patients, and how this is influenced by concomitantanticoagulant therapy. The aim was to describe the evolution and filterretrieval of patients with acute episode of symptomatic VTE requiring IVCF,according subgroup of concomitant therapy received.Methods: Retrospective cohort of all patients with acute symptomaticVTE and IVCF, included in the Institutional Register of Thromboembolism(Institutional Registry of Thromboembolic.-ClinicalTrials.gov, NCT01372514)between 2006 and 2014, in the Hospital Italiano, Buenos Aires, Argentina.Outcomes measures at followed up were filter retrieval, VTE complicationsand death. We modeled the cumulative incidence of filter retrieval inthe presence of competing event death, estimated with competitive riskregression, according to the type of treatment (no treatment, prophylaxisor anticoagulation). Crude (HRc) and adjusted sub hazard ratios (HRa) werereported.Results: We included 321 patients with VTE and FVCI. The main indicationsfor placement were absolute contraindication to therapeutic anticoagulation(41%), and need to suspend anticoagulation for invasive procedure (35%).The overall mortality was 47%, being higher in those without treatmentand lowest in the anticoagulation group (70 vs. 36%, p 0.01). The maincomplications during follow-up were recurrence of VTE (16%) and bleeding(11%), with no difference between groups. The cumulative filter retrievalin the presence of competing event death at 30 and 90 days were: 6% and8% for no treatment, 30% and 38% for prophylaxis, and 40% and 50% foranticoagulation group. The retrieval rate was higher in patients who werereceiving anticoagulation, and lower in patients with cancer comparedwith no treatment group. The hazard for filter retrieval in the presenceof competing event death compared with no treatment group were: HRc7.09 (CI95%2.5-20.11) and HRa 6.70 (CI95%2.35-19.06) for prophylaxisgroup, HRc 10.48 (CI95%3.86-28.45) and HRa 9.82 (CI95%3.60-26.76) foranticoagulation group.Conclusions: Mortality in this group of patients was high. Failure to filterremoval was associated with concomitant cancer and no anticoagulation.