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

• Published in: JAMA network open 2020-07, Vol.3 (7), p.e2011079-e2011079
• Main Authors: Balabhadra, Samyuktha, Kuban, Joshua D, Lee, Stephen, Yevich, Steven, Metwalli, Zeyad, McCarthy, Colin J, Huang, Steven Y, Tam, Alda, Gupta, Sanjay, Sheth, Sunil A, Sheth, Rahul A
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; California; Cancer; Child; Child, Preschool; Cohort Studies; Female; Humans; Infant; Lower Extremity - blood supply; Lower Extremity - physiopathology; Male; Middle Aged; Neoplasms - complications; Neoplasms - surgery; Odds Ratio; Oncology; Online Only; Original Investigation; Prostate cancer; Pulmonary Embolism - epidemiology; Pulmonary embolisms; Risk assessment; Risk Factors; Thrombosis; Treatment Outcome; Tumors; Vena Cava Filters; Venous Thrombosis - etiology; Venous Thrombosis - surgery
• ISSN: 2574-3805; 2574-3805
• DOI: 10.1001/jamanetworkopen.2020.11079

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