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#Grand Rounds

Is IVC Filter Placement in VTE Patients Associated with Increased Mortality?

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BACKGROUND AND PURPOSE:

  • Many professional societies recommend the use of inferior vena cava (IVC) filters for patients with venous thromboembolic disease (VTE) who cannot use anticoagulation therapy
    • However, evidence for this recommendation is limited, especially with respect to mortality  
  • Immortal time bias
    • Time before IVC insertion, during which death can only occur in the control group
    • Previous observational studies may not have taken this bias in to account when demonstrating benefit of IVC filters
  • Turner et al. (JAMA Netw Open., 2018) sought to assess the association of IVC filter placement with 30-day mortality when appropriately adjusting for immortal time bias

METHODS:

  • Comparative effectiveness, retrospective cohort study
  • Participants
    • Hospitalized patients with VTE and a contraindication to anticoagulation
  • Data sources
    • State Inpatient Database and the State Emergency Department Database  
    • California, Florida, and New York
    • Study performed as part of the Healthcare Cost and Utilization Project of the AHRQ
  • Exposure
    • Inferior vena cava filter placement
  • Study design
    • Multivariable Cox proportional hazard models
    • IVC filters considered a time-dependent variable to adjust for immortal time bias
    • The Cox model was further adjusted using the propensity score as an adjustment variable
  • Primary outcome
    • 30-day mortality with adjustment for immortal time bias

RESULTS:

  • 126,030 patients with VTE
    • 52.4% female | Mean age 66.9 years
    • 36.3% treated with an IVC filter | 63.7% no filter
  • IVC filter placement was associated with a significantly increased 30-day mortality (adjusted for immortal time bias)
    • Hazard ratio (HR) 1.18 (95% CI, 1.13 to 1.22; P < 0.001)
  • IVC filter placement remained associated with an increased risk when propensity scoring applied to 30-day mortality
    • HR 1.18 (95% CI, 1.13 to 1.22; P < 0.001)

CONCLUSION:

  • IVC filter placement was associated with increased 30-day mortality in patients with VTE and a contraindication to anticoagulation
  • RCTs will be needed to determine the true efficacy of IVC filter placement in this clinical setting

Learn More – Primary Sources:

Association of Inferior Vena Cava Filter Placement for Venous Thromboembolic Disease and a Contraindication to Anticoagulation With 30-Day Mortality

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Related ObG Topics:

What is the Risk for Recurrent VTE after Stopping Anticoagulation Treatment?
When to Stop Anticoagulation Following a DVT or Pulmonary Embolus?
Can Genotype-Guided Dosing Decrease Warfarin Complications?

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