Practice Patterns of Inferior Vena Cava Filter Placement and Factors That Predict Retrieval Rates: A Single-Center Institution and Review of the Literature

Factors Associated With Inferior Vena Cava Filter Placement and Retrieval for Patients With Cancer-Associated Thrombosis

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.

Inferior vena cava filters utilization in patients with venous thromboembolism: Analysis of a database of a tertiary hospital

PURPOSE

The aim of the study was to assess the inferior vena cava filter (IVCF) utilization in patients with venous thromboembolism (VTE) in tertiary care.

METHODS

We performed a retrospective analysis of database of a tertiary hospital in 2016-2017. All the records of patients admitted for VTE or diagnosed with VTE being hospitalized for other reasons were extracted. The data collected were number of patients, who received IVCF, indications to filter insertion, PE and death rate after procedure, frequency of IVCF occlusion.

RESULTS

2399 patients with VTE were admitted to hospital. 442 (18,4%) of them received IVCF (239 in 2016 and 203 in 2017). Retrievable models were used in most cases (98,8%). In 119 (5,0%) patients cava filters were used due to contraindications for anticoagulation, while in 184 (7,7%) patients' anticoagulation was not effective and thrombosis progression was registered. 101 (4,2%) patients received IVCF due to high PE risk (length of floating thrombus ≥7 cm, in proximal location), high pulmonary hypertension was indication to IVCF insertion in 38 (1,6%) patients with deep vein thrombosis (DVT) in combination with pulmonary embolism (PE). Overall mortality rate after IVCF insertion was 5 (0,2%). No fatal PE was registered. IVCF occlusion during hospitalization occurred in 116 (4,8%) cases. Only 29 (1,2%) of patients were admitted back for IVCF removal.

CONCLUSIONS

Every one in five patients with proximal DVT and/or PE receives IVCF in a routine practice in tertiary hospital. The most common indications for IVCF implantation were inability for anticoagulation or anticoagulation failure. Removal rate of retrievable cava filters is low.

Inferior Vena Cava Filter in Cancer Patients: On Whom Should We Be Placing Them?

BACKGROUND

Standard treatment for venous thromboembolism is anticoagulation; vena cava filter placement is an alternative in special situations. We aimed to evaluate the outcomes in patients with cancer undergoing filter placement in a cancer center during a 10-year period and assess which preoperatory variables were associated with poorer survival.

METHODS

Retrospective unicenter analysis during a 10-year period was carried out in patients with cancer who had undergone placement of vena cava filter. Early deaths were those that occurred less than 30 days after the filter placement or that occurred during the same hospital stay of the placement.

RESULTS

About 250 patients were analyzed. About 51.6% were females; 77.2% had proximal lower limb deep vein thrombosis; 34.8% had contraindications to anticoagulation; 32.8% presented bleeding after the onset of anticoagulation; and 18.4% had the filter implanted because they were going to undergo surgery and could not be anticoagulated immediately after. About 51.2% of the filters were removable. However, only 2 had the filter removed. About 59.2% had metastatic disease at the time of filter placement. About 31.2% fulfilled criteria for early death. Of those, 34 patients were put in palliative care after filter insertion (median, 13.5 days). Body mass index >18 kg/m², the absence of metastatic disease, and filter placement during the same anesthesia of another surgery (especially if elective and curative) were associated with a higher chance of survival.

CONCLUSIONS

Multidisciplinary evaluation (and possibly consideration for palliation) should take place before the decision to insert a vena cava filter in severe oncologic cases depending on overall status. Patients with a greater chance of survival at a 3 or 5 years interval seem to be those whose filters were placed in the perioperative context of other surgeries (specially elective and curative), who were not undernourished, and whose disease was not metastatic at that time. For patients who survived, an active investigation protocol for filter removal should be implemented.

A better inferior vena cava filter retrieval rate: A retrospective study in a single-center institution

Purpose

To determine practice patterns of inferior vena cava filters (IVCFs), retrieval rates, and reasons why retrievable-IVCFs (R-IVCFs) are kept permanent.

Methods

A total of 399 patients who received IVCFs at Third Hospital of Hebei Medical University from January 2017 to December 2017 were registered and retrospectively studied. Date of demographics, baseline medical history, dwell time, reasons why R-IVCFs were kept permanent, and R-IVCFs thrombus were collected.

Results

A total of 399 IVCFs were placed during the study period including 27 permanent IVCFs and 372 R-IVCFs. Among all patients who received R-IVCFs, the mean dwell time was 18.25 ± 16.60 days, follow-up rate was 96.24% (358/372), and 337 R-IVCFs were attempted to be removed. Except one, 336 R-IVCFs were retrieved successfully (336/372, 90.32%). Sixty-four R-IVCFs thrombi were found during retrieval including 53 small-size thrombi (< 1 cm × 1 cm) and 13 large-size thrombi (>1 cm × 1 cm). Fifty-three R-IVCFs with small-size thrombi were removed successfully with no additional treatments. Twelve large-size thrombi were retrieved successfully after catheter-directed thrombolysis.

Conclusions

With good follow-up, the retrieval rate could be improved to 90.32%. The main reasons why R-IVCFs were kept permanent were to avoid losing follow-up and overcome inappropriate selections of indications or IVCF types. And R-IVCFs with thrombus could be removed safely.

Outcomes of Using IVC Filters in Patients with Malignancy at an Academic Medical Center

Systemic anticoagulation is regarded as optimal treatment and prophylaxis of venous thromboembolism (VTE). In malignancy, bleeding risk is increased while the patients remain hypercoagulable, making anticoagulation management troublesome. Inferior vena cava (IVC) filters have emerged as an option in the management of VTE, especially when anticoagulant agents are contraindicated. There is limited data on the overall outcomes of patients with malignancy and IVC filter placement. This descriptive study identifies individuals with filters placed and reviews outcomes to guide appropriate care of patients with malignancy and VTE. We performed a retrospective chart review of 115 patients with malignancy who had a filter placed between July 2014 and December 2016. Eighty-seven patients were tracked until December 2017 for significant events (VTE and/or death). In total, 61% ( n  = 70) had metastatic solid tumor malignancy and 77% ( n  = 88) were receiving anticoagulation therapy prior to IVC filter placement. Fifty-three percent ( n  = 61) had bleeding events and 25% ( n  = 29) had thrombocytopenia. Patients with isolated solid tumors receiving frequent surgery were also common recipients of filters. Sixty-six percent (57/87) of patients had a significant event; 85% of them were anticoagulated. Eighty-two percent of events occurred within 6 months of filter placement, with death occurring on average within 5 months of placement. Overall, use of IVC filters was more common in cancer patients who developed bleeding complications on anticoagulation and with metastatic malignancy. However, in patients with metastatic or hematologic disease, filter placement did not prevent all-cause mortality. Individualized risk-benefit consideration is needed before IVC filters are placed.