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Makary MS, Koso M, Yoder M. Inferior vena cava filter thromboprophylaxis in surgical cancer patients. J Surg Oncol 2024; 130:257-264. [PMID: 38865285 DOI: 10.1002/jso.27734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 04/04/2024] [Accepted: 06/04/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND AND OBJECTIVES This study evaluated the utilization and outcomes of inferior vena cava (IVC) filters as thromboprophylaxis in cancer patients undergoing surgery. METHODS This single-center retrospective study analyzed baseline patient characteristics and clinical outcomes of surgical cancer patients who received perioperative prophylactic IVC filters. Primary clinical endpoints included venous thromboembolism (VTE) incidence and filter complications. A statistical correlative analysis was conducted to identify risk factors related to pulmonary embolism (PE), deep vein thrombosis (DVT), and filter thrombi, as well as advanced technique filter removal and mortality at 6 months. RESULTS A total of 252 surgical oncology patients (median age, 59; female 51%) received IVC filters for the perioperative prevention of PE. Primary surgical sites included spine (n = 91, 36%), orthopedic extremity/joint (n = 49, 19%), genitourinary (n = 47, 19%), brain/cranial (n = 40, 16%), abdominal (n = 18, 7%), multisite (n = 4, 2%), and chest (n = 3, 1%). Moreover, 15% of patients experienced DVTs in the postplacement preretrieval period, while 2% (n = 6) of patients experienced definitive PEs. A total of 36% of IVC filters were ultimately retrieved, with an average filter dwell time of 7.4 months. Complications occurred in one retrieval. CONCLUSION Prophylactic perioperative IVC filters in surgical cancer patients resulted in minimal complications while ultimately resulting in a low incidence of PE.
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Affiliation(s)
- Mina S Makary
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mensur Koso
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Matthew Yoder
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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López N, Zamora-Martinez C, Montoya-Rodes M, Gabara C, Ortiz M, Aibar J. Comparison of inferior vena cava filter use and outcomes between cancer and non-cancer patients in a tertiary hospital. Thromb Res 2024; 236:136-143. [PMID: 38447420 DOI: 10.1016/j.thromres.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND While accepted indications for the use of inferior vena cava filter (IVCF) in patients with a venous thromboembolism (VTE) have remained stable, their use continues to be frequent. Retrieval rates are still low, being particularly notable in the population with cancer. This study aims to review the rate of adherence to guidelines recommendation and to compare retrieval rates and complications in both cancer and non-cancer patients. METHODS A retrospective study was performed including 185 patients in whom an IVCF was placed in Hospital Clinic of Barcelona. Baseline characteristics, clinical outcomes, and IVCF-related outcomes were analyzed. A strongly recommended indication (SRI) was considered if it was included in all the revised clinical guidelines and non-strongly if it was included in only some. RESULTS Overall, 47 % of the patients had a SRI, without differences between groups. IVCF placement after 29 days from the VTE event was more frequent in the cancer group (46.1 vs. 17.7 %). Patients with cancer (48.1 % of the cohort) were older, with higher co-morbidity and bleeding risk. Anticoagulation resumption (75.3 % vs. 92.7 %) and IVCF retrieval (50.6 % vs. 66.7 %) were significantly less frequent in cancer patients. No significant differences were found regarding IVCF-related complications, hemorrhagic events and VTE recurrence. CONCLUSIONS SRI of IVCF placement was found in less than half of the patients. Cancer patients had higher rates of IVCF placement without indication and lower anticoagulation resumption and IVCF retrieval ratios, despite complications were similar in both groups.
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Affiliation(s)
- Néstor López
- Internal Medicine Department, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Carles Zamora-Martinez
- Medical Oncology Department, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.
| | - Marc Montoya-Rodes
- Internal Medicine Department, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Cristina Gabara
- Internal Medicine Department, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - María Ortiz
- Internal Medicine Department, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Jesús Aibar
- Internal Medicine Department, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
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Li X, Partovi S, Gadani S, Martin C, Beck A, Vedantham S. Gastrointestinal Malignancies and Venous Thromboembolic Disease: Clinical Significance and Endovascular Interventions. ACTA ACUST UNITED AC 2020; 4:260-266. [PMID: 34296054 DOI: 10.1055/s-0040-1716739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Gastrointestinal malignancy encompasses a wide range of disease processes. Its incidence and mortality rate rank among the highest of all cancers. Venous thromboembolic disease is a common complication of gastrointestinal malignancy. Anticoagulation remains the first-line therapy. However, for patients who cannot tolerate or have failed anticoagulation, inferior vena cava (IVC) filter placement may be an option. Furthermore, to improve symptom resolution and reduce the severity of postthrombotic syndrome, catheter-directed thrombolysis (CDT) may be an option. Recent randomized trials including the ATTRACT (Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis) trial have shed new light on the efficacy and safety of CDT and related methods. Overall, the decision to proceed with IVC filter placement or CDT must be individualized.
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Affiliation(s)
- Xin Li
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, Ohio
| | - Sasan Partovi
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, Ohio
| | - Sameer Gadani
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, Ohio
| | - Charles Martin
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, Ohio
| | - Avi Beck
- Section of Interventional Radiology, Imaging Institute, Cleveland Clinic Main Campus, Cleveland, Ohio
| | - Suresh Vedantham
- Section of Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
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Pachón V, Trujillo-Santos J, Domènech P, Gallardo E, Font C, González-Porras JR, Pérez-Segura P, Maestre A, Mateo J, Muñoz A, Peris ML, Lecumberri R. Cancer-Associated Thrombosis: Beyond Clinical Practice Guidelines-A Multidisciplinary (SEMI-SEOM-SETH) Expert Consensus. TH OPEN 2018; 2:e373-e386. [PMID: 31249964 PMCID: PMC6524906 DOI: 10.1055/s-0038-1675577] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 09/17/2018] [Indexed: 02/07/2023] Open
Abstract
Despite the growing interest and improved knowledge about venous thromboembolism in cancer patients in the last years, there are still many unsolved issues. Due to the limitations of the available literature, evidence-based clinical practice guidelines are not able to give solid recommendations for challenging scenarios often present in the setting of cancer-associated thrombosis (CAT). A multidisciplinary expert panel from three scientific societies—Spanish Society of Internal Medicine (SEMI), Spanish Society of Medical Oncology (SEOM), and Spanish Society Thrombosis and Haemostasis (SETH)—agreed on 12 controversial questions regarding prevention and management of CAT, which were thoroughly reviewed to provide further guidance. The suggestions presented herein may facilitate clinical decisions in specific complex circumstances, until these can be made leaning on reliable scientific evidence.
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Affiliation(s)
- Vanessa Pachón
- Department of Oncology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Pere Domènech
- Thrombosis and Haemostasis Unit, Hospital Universitario Bellvitge, L'Hospitalet de Llobregat, Catalonia, Spain
| | - Enrique Gallardo
- Department of Oncology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Carmen Font
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
| | | | | | - Ana Maestre
- Department of Internal Medicine, Hospital del Vinalopó, Elche, Spain
| | - José Mateo
- Hematology Service, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Andrés Muñoz
- Department of Oncology, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - María Luisa Peris
- Department of Internal Medicine, Hospital Provincial de Castellón, Castellón, Spain
| | - Ramón Lecumberri
- Hematology Service, Clínica Universidad de Navarra, IDISNA, CIBER-CV, Pamplona, Spain
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Khan M, Cox TM, Nassif M, Alzubaidi MA, Garg N, Qiao W, Aung FM, Oo TH, Rojas-Hernandez CM. Comparative outcomes of thrombocytopenic acute leukemic patients with venous thromboembolism at a Comprehensive Cancer Center. J Thromb Thrombolysis 2018; 45:377-385. [DOI: 10.1007/s11239-018-1621-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Coombs C, Kuk D, Devlin S, Siegelbaum RH, Durack JC, Parameswaran R, Mantha S, Deng K, Soff G. Outcomes after inferior vena cava filter placement in cancer patients diagnosed with pulmonary embolism: risk for recurrent venous thromboembolism. J Thromb Thrombolysis 2017; 44:489-493. [DOI: 10.1007/s11239-017-1557-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Pandhi MB, Desai KR, Ryu RK, Lewandowski RJ. The Role of Inferior Vena Cava Filters in Cancer Patients. Semin Intervent Radiol 2016; 33:71-4. [PMID: 27247473 DOI: 10.1055/s-0036-1581090] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cancer induces a hypercoagulable state and renders patients susceptible to venous thromboembolism. While anticoagulation remains the mainstay of treatment, many of these patients require placement of an inferior vena cava (IVC) filter, often due to a contraindication to or failure of anticoagulation. In this article, the available data on IVC filter usage in cancer patients will be reviewed.
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Affiliation(s)
- Mithil B Pandhi
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kush R Desai
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Robert K Ryu
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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