IVC Filters Tied to Higher Mortality in Seniors with PE

Elderly patients with acute pulmonary embolism (PE) who receive an inferior vena cava (IVC) filter face a higher death risk, according to a new study.

Researchers at New York-Presbyterian Hospital/Columbia University Medical Center (NYP; New York, NY, USA), Universidad de Alcalá (Madrid, Spain), and Brigham and Women’s Hospital (BWH; Boston, MA, USA) conducted a study that examined data from 214,000 Medicare inpatient claims so as to evaluate the association between the use of IVC filters and mortality rates in older patients (mean age 77.8 years) who were hospitalized for acute PE. Of these patients, 13.4% received an IVC filter.

The results revealed that patients that received an IVC filter had a higher 30-day mortality rate (11.6%) than those who did not receive a filter (9.3%). One-year mortality rates among those who survived longer than 30 days were higher in unadjusted analysis (20.5%) in the IVC filter group, compared to the non-IVC-filter group (13.4%). Results were similar in matched cohort analyses, where the IVC filter group had 61% higher odds for 30-day mortality and 2.19-fold increased odds for one-year mortality compared with the non-filter group. The study was published on December 10, 2018, in JAMA Internal Medicine.

“Until we obtain additional high-quality data from prospective (ideally randomized) studies, we caution against the overuse of IVC filters in the broad population of patients at-risk of venous thromboembolism (VTE),” said lead author Behnood Bikdeli, MD, of NYP. “There may be still a small subset of patients, including those with clinically important acute VTE and absolute contraindication for anticoagulation, or recurrent PE despite optimal anticoagulation, in whom use of IVC filters may be considered according to the expert guidelines.”

Since the invention of the permanent percutaneous IVC filter in 1973 and the retrievable IVC filter in the 1990s, its use has become a standard part of treatment for select patients with acute lower-extremity venous thrombosis who cannot receive anticoagulation. Placement of an IVC filter is thus frequently considered in trauma patients because of the high risk of VTE associated with traumatic injury and the risks of anticoagulation in this population. In recent years, the U.S. Food and Drug Administration (FDA) raised concerns about the safety of IVC filters, and some studies have indicated a temporal decrease in the use of this technology.

Related Links:
New York-Presbyterian Hospital/Columbia University Medical Center
Universidad de Alcalá
Brigham and Women’s Hospital