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Schastlivtsev I, Pankov A, Tsaplin S, Stepanov E, Zhuravlev S, Lobastov K. Oral Rivaroxaban Versus Warfarin After inferior Vena cava Filter Implantation: A Retrospective Cohort Study. Clin Appl Thromb Hemost 2024; 30:10760296241256938. [PMID: 38778542 PMCID: PMC11113020 DOI: 10.1177/10760296241256938] [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: 01/31/2024] [Revised: 04/16/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVES To assess the efficacy and safety of rivaroxaban compared to warfarin after inferior vena cava (IVC) filter implantation. METHOD This retrospective analysis includes data from 100 patients with deep vein thrombosis (DVT) who underwent IVC filter implantation due to a free-floating thrombus (n = 64), thrombus propagation (n = 8), or acute bleeding (n = 8) on therapeutic anticoagulation, catheter-directed thrombolysis (n = 8), or had previously implanted filter with DVT recurrence. Patients were treated with warfarin (n = 41) or rivaroxaban (n = 59) for 3-12 months. Symptomatic venous thromboembolism (VTE) recurrence and bleeding events were assessed at 12 months follow-up. RESULTS Three (7.3%) cases of VTE recurrence without IVC filter occlusion occurred on warfarin and none on rivaroxaban. The only (2.4%) major bleeding occurred on warfarin. Three (5.1%) clinically relevant non-major bleedings were detected on rivaroxaban. No significant differences existed between groups when full and propensity scores matched datasets were compared. CONCLUSIONS Rivaroxaban seems not less effective and safe than warfarin after IVC filter implantation.
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Affiliation(s)
- Ilya Schastlivtsev
- Department of General Surgery, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Aleksey Pankov
- Clinical Hospital No. 1 of the President's Administration of the Russian Federation, Moscow, Russia
| | - Sergey Tsaplin
- Department of General Surgery, Pirogov Russian National Research Medical University, Moscow, Russia
- Clinical Hospital No. 1 of the President's Administration of the Russian Federation, Moscow, Russia
| | - Evgeny Stepanov
- Department of General Surgery, Pirogov Russian National Research Medical University, Moscow, Russia
| | - Sergey Zhuravlev
- Clinical Hospital No. 1 of the President's Administration of the Russian Federation, Moscow, Russia
| | - Kirill Lobastov
- Department of General Surgery, Pirogov Russian National Research Medical University, Moscow, Russia
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Edupuganti S, Li M, Wu Z, Basu T, Barnes GD, Carrier M, Sood SL, Griggs JJ, Schaefer JK. Factors Associated With Inferior Vena Cava Filter Placement and Retrieval for Patients With Cancer-Associated Thrombosis. Am J Med 2022; 135:478-487.e5. [PMID: 34861200 DOI: 10.1016/j.amjmed.2021.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/08/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Venous thromboembolism is a leading cause of death in patients with cancer. Inferior vena cava filters are utilized to mitigate the risk of pulmonary embolism for patients who have contraindication to, or failure of, anticoagulation. METHODS We reviewed an insurance claims database to identify adults receiving cancer-directed therapy and had a new diagnosis of venous thromboembolism. We then evaluated clinical and sociodemographic characteristics in patients with and without filter placement and retrieval. RESULTS There were 25,788 patients (mean [SD] age: 68.3 [12.7] years) who met the study inclusion criteria, with 2111 individuals (8.2%) undergoing filter placement. Filter placement was associated with the type of thrombosis, malignancy, recent surgery, comorbidities, and income. A total of 137 patients (6.5%) newly started anticoagulation within 3 days of filter placement, and 612 (29%) patients received anticoagulation within 30 days after filter placement. Despite this, only 159 (7.5%) patients had their filters retrieved during the study period. Patients with income of $75-99K (odds ratio 2.13, P = .012) or above $100K (odds ratio 1.8, P = .038) were more likely to have filter retrieval compared with those with income <$50K. Filter retrieval was also more likely in younger patients and those with fewer comorbidities or without central nervous system or lung malignancies. CONCLUSIONS Inferior vena cava filter placement and retrieval are associated with several sociodemographic factors. Filter retrieval rates are low despite re-initiation of anticoagulation in many patients. Efforts are needed to address disparities in filter use and improve retrieval rates.
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Affiliation(s)
| | | | - Zhenke Wu
- Department of Biostatistics; Michigan Institute for Data Science; Institute for Social Research
| | - Tanima Basu
- Institute for Healthcare Policy and Innovation
| | - Geoffrey D Barnes
- Institute for Healthcare Policy and Innovation; Department of Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor
| | - Marc Carrier
- Department of Medicine, The Ottawa Hospital Research Institute at the University of Ottawa, Ont, Canada
| | - Suman L Sood
- Department of Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor
| | - Jennifer J Griggs
- Institute for Healthcare Policy and Innovation; Department of Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor
| | - Jordan K Schaefer
- Department of Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor.
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Leader A, Gurevich-Shapiro A, Spectre G. Anticoagulant and antiplatelet treatment in cancer patients with thrombocytopenia. Thromb Res 2020; 191 Suppl 1:S68-S73. [DOI: 10.1016/s0049-3848(20)30400-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/23/2019] [Accepted: 01/03/2020] [Indexed: 12/30/2022]
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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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Chen M, Goodin A, Xiao H, Han Q, Raissi D, Brown J. Hospitalization metrics associated with hospital-level variation in inferior vena cava filter utilization for patients with venous thromboembolism in the United States: Implications for quality of care. Vasc Med 2018; 23:365-371. [PMID: 29781388 DOI: 10.1177/1358863x18768685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Variation in the use of inferior vena cava filters (IVCFs) across hospitals has been observed, suggesting differences in quality of care. Hospitalization metrics associated with venous thromboembolism (VTE) patients have not been compared based on IVCF utilization rates using a national sample. We conducted a descriptive retrospective study using the Nationwide Readmissions Database (NRD) to delineate the variability of hospitalization metrics across the hospital quartiles of IVCF utilization for VTE patients. The NRD included all-payer administrative inpatient records drawn from 22 states. Adult (≥ 18 years) patients with VTE hospitalizations with or without IVCF were identified from January 1, 2013 through December 31, 2014 and hospitals were divided into quartiles based on the IVCF utilization rate as a proportion of VTE patients. Primary outcome measures were observed rates of in-hospital mortality, 30-day all-cause readmissions and VTE-related readmissions, cost, and length of stay. Patient case-mix characteristics and hospital-level factors by hospital quartiles of IVCF utilization rates, were compared. Overall, 12.29% of VTE patients had IVCF placement, with IVCF utilization ranging from 0% to 46.84%. The highest quartile had fewer pulmonary embolism patients relative to deep vein thrombosis patients, and older patient ages were present in higher quartiles. The highest quartile of hospitals placing IVCFs were more often private, for-profit, and non-teaching. Patient and hospital characteristics and hospitalization metrics varied by IVCF utilization rates, but hospitalization outcomes for non-IVCF patients varied most between quartiles. Future work investigating the implications of IVCF utilization rates as a measure of quality of care for VTE patients is needed.
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Affiliation(s)
- Ming Chen
- 1 Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Amie Goodin
- 1 Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Hong Xiao
- 1 Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Qiong Han
- 2 Department of Radiology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Driss Raissi
- 2 Department of Radiology, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Joshua Brown
- 1 Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, FL, USA
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Geerts W, Selby R. Inferior vena cava filter use and patient safety: legacy or science? HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2017; 2017:686-692. [PMID: 29222322 PMCID: PMC6142573 DOI: 10.1182/asheducation-2017.1.686] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
There has been a dramatic increase in vena cava filter (VCF) use over the past 20 years in the absence of evidence that filters provide a net patient benefit or are required in most cases. This increase is largely attributable to the availability of retrievable filters and expanded indications, particularly as primary prophylaxis in patients thought to be at high risk of pulmonary embolism. Substantial variability in VCF use, unrelated to patient clinical factors, has been shown between hospitals, from region to region, and among various countries. Despite the lack of direct evidence for the benefit of VCFs for any indication, it is appropriate to insert a retrievable VCF in patients with a recent proximal deep vein thrombosis and an absolute contraindication to therapeutic anticoagulation and then to remove the filter once the bleeding risk decreases and the patient has been anticoagulated. Unfortunately, a high proportion of retrievable filters are not removed, even after the reason for their placement has long passed. Retrievable filters are associated with substantial rates of complications if they are not removed, including penetration of the vena caval wall, fracture and embolization of filter fragments, and caval occlusion. Patient safety priorities and medical-legal concerns mandate careful selection of patients for VCF placement and removal shortly after anticoagulation has been initiated.
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Affiliation(s)
- William Geerts
- Thromboembolism Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada; and
| | - Rita Selby
- Thromboembolism Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada; and
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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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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Brunson A, Ho G, White R, Wun T. Inferior vena cava filters in patients with cancer and venous thromboembolism (VTE) does not improve clinical outcomes: A population-based study. Thromb Res 2017; 153:57-64. [DOI: 10.1016/j.thromres.2017.03.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 02/17/2017] [Accepted: 03/11/2017] [Indexed: 12/21/2022]
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Yoon L, Clarke Hillyer G, Chen L, Hu JC, Neugut AI, Hershman DL, Wright JD. Predictors of Interventional Treatment Use for Venous Thromboembolism in Cancer Patients. Cancer Invest 2016; 34:408-14. [PMID: 27624740 DOI: 10.1080/07357907.2016.1221078] [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: 10/21/2022]
Abstract
Venous thromboembolic disease is a major cause of morbidity in cancer patients. The Perspective database was used to identify patients with solid tumors and a diagnosis of VTE from 2006 to 2012. We examined use of IVC filters, thrombolysis, and thrombectomy. Among 32,545 patients, 23.1% received an IVC filter, 1.9% thrombolytic therapy, and 0.4% underwent thrombectomy. Use of IVC filters decreased between 2006 and 2012 (23.4% to 21.2%, p = 0.012). Older patients, uninsured patients, Hispanics, and those with more comorbidities were more likely to undergo filter placement while patients at rural hospitals were less likely to receive an IVC filter (p < 0.05 for all).
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Affiliation(s)
- Lara Yoon
- a Department of Epidemiology , Mailman School of Public Health, Columbia University , New York , New York , USA
| | - Grace Clarke Hillyer
- a Department of Epidemiology , Mailman School of Public Health, Columbia University , New York , New York , USA.,b Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center , New York , New York , USA
| | - Ling Chen
- c College of Physicians and Surgeons, Columbia University , New York , New York , USA
| | - Jim C Hu
- d Department of Urology , Weill Cornell Medical College , New York , New York , USA.,e New York Presbyterian Hospital , New York , New York , USA
| | - Alfred I Neugut
- a Department of Epidemiology , Mailman School of Public Health, Columbia University , New York , New York , USA.,b Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center , New York , New York , USA.,c College of Physicians and Surgeons, Columbia University , New York , New York , USA.,e New York Presbyterian Hospital , New York , New York , USA
| | - Dawn L Hershman
- a Department of Epidemiology , Mailman School of Public Health, Columbia University , New York , New York , USA.,b Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center , New York , New York , USA.,c College of Physicians and Surgeons, Columbia University , New York , New York , USA.,e New York Presbyterian Hospital , New York , New York , USA
| | - Jason D Wright
- b Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center , New York , New York , USA.,c College of Physicians and Surgeons, Columbia University , New York , New York , USA.,e New York Presbyterian Hospital , New York , New York , USA
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Casazza F, Becattini C, Rulli E, Pacchetti I, Floriani I, Biancardi M, Scardovi AB, Enea I, Bongarzoni A, Pignataro L, Agnelli G. Clinical presentation and in-hospital death in acute pulmonary embolism: does cancer matter? Intern Emerg Med 2016; 11:817-24. [PMID: 27023066 DOI: 10.1007/s11739-016-1431-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 02/28/2016] [Indexed: 10/22/2022]
Abstract
Cancer is one of the most common risk factors for acute pulmonary embolism (PE), but only few studies report on the short-term outcome of patients with PE and a history of cancer. The aim of the study was to assess whether a cancer diagnosis affects the clinical presentation and short-term outcome in patients hospitalized for PE who were included in the Italian Pulmonary Embolism Registry. All-cause and PE-related in-hospital deaths were also analyzed. Out of 1702 patients, 451 (26.5 %) of patients had a diagnosis of cancer: cancer was known at presentation in 365, or diagnosed during the hospital stay for PE in 86 (19 % of cancer patients). Patients with and without cancer were similar concerning clinical status at presentation. Patients with cancer less commonly received thrombolytic therapy, and more often had an inferior vena cava filter inserted. Major or intracranial bleeding was not different between groups. In-hospital all-cause death occurred in 8.4 and 5.9 % of patients with and without cancer, respectively. At multivariate analysis, cancer (OR 2.24, 95 % CI 1.27-3.98; P = 0.006) was an independent predictor of in-hospital death. Clinical instability, PE recurrence, age ≥75 years, recent bed rest ≥3 days, but not cancer, were independent predictors of in-hospital death due to PE. Cancer seems a weaker predictor of all-cause in-hospital death compared to other factors; the mere presence of cancer, without other risk factors, leads to a probability of early death of 2 %. In patients with acute PE, cancer increases the probability of in-hospital all-cause death, but does not seem to affect the clinical presentation or the risk of in-hospital PE-related death.
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Affiliation(s)
- Franco Casazza
- Cardiology Division, Ospedale San Carlo Borromeo, Milan, Italy
| | - Cecilia Becattini
- Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Via G Dottori 1, Perugia, Italy.
| | - Eliana Rulli
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Ilaria Pacchetti
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Irene Floriani
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Marco Biancardi
- Division of Internal Medicine, Ospedale San Carlo Borromeo, Milan, Italy
| | | | - Iolanda Enea
- UO Medicina d'Urgenza, AORN S. Anna e S. Sebastiano, Caserta, Italy
| | | | - Luigi Pignataro
- Cardiology Division, Ospedale San Carlo Borromeo, Milan, Italy
| | - Giancarlo Agnelli
- Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Via G Dottori 1, Perugia, Italy
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Brunson A, Ho G, White R, Wun T. Inferior vena cava filters in patients with cancer and venous thromboembolism (VTE): patterns of use and outcomes. Thromb Res 2016; 140 Suppl 1:S132-41. [DOI: 10.1016/s0049-3848(16)30112-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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