Vena cava filters in patients presenting with major bleeding during anticoagulation for venous thromboembolism

Meritxell Mellado, Javier Trujillo-Santos, Behnood Bikdeli, David Jiménez, Manuel Jesús Núñez, Martin Ellis, Pablo Javier Marchena, Jerónimo Ramón Vela, Albert Clara, Farès Moustafa, Manuel Monreal, M. D. Adarraga, M. A. Aibar, M. Alfonso, J. I. Arcelus, A. Ballaz, P. Baños, R. Barba, M. Barrón, J. BascuñanaA. Blanco-Molina, A. M. Camon, C. Carrasco, L. Chasco, A. J. Cruzs, R. del Pozo, J. del Toro, M. C. Díaz-Pedroche, J. A. Díaz-Peromingo, M. Encabo, C. Falgá, C. Fernández-Aracil, C. Fernández-Capitán, M. A. Fidalgo, C. Font, L. Font, I. Furest, M. A. García, F. García-Bragado, M. García-Morillo, A. García-Raso, I. García-Sánchez, O. Gavín, C. Gómez, V. Gómez, J. González, E. Grau, R. Guijarro, L. Guirado, J. Gutiérrez, L. Hernández-Blasco, E. Hernando, V. Isern, L. Jara-Palomares, M. J. Jaras, David Jiménez, M. D. Joya, J. Lima, P. Llamas, J. L. Lobo, L. López-Jiménez, R. López-Reyes, J. B. López-Sáez, M. A. Lorente, A. Lorenzo, M. Loring, M. Lumbierres, O. Madridano, A. Maestre, P. J. Marchena, M. Martín, F. Martín-Martos, Meritxell Mellado, M. Monreal, M. V. Morales, J. A. Nieto, M. J. Núñez, M. C. Olivares, S. Otalora, R. Otero, J. M. Pedrajas, G. Pellejero, C. Pérez-Ductor, M. L. Peris, I. Pons, J. A. Porras, A. Riera-Mestre, A. Rivas, M. A. Rodríguez-Dávila, I. Rodríguez-Galán, V. Rosa, C. M. Rubio, P. Ruiz-Artacho, J. C. Sahuquillo, M. C. Sala-Sainz, A. Sampériz, B. Sánchez-Artola, R. Sánchez-Martínez, T. Sancho, S. Soler

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Abstract

© 2019, Società Italiana di Medicina Interna (SIMI). The association between inferior vena cava filter (IVC) use and outcome in patients presenting with major bleeding during anticoagulation for venous thromboembolism (VTE) has not been thoroughly investigated. We used the RIETE registry to compare the 30-day outcomes (death, major re-bleeding or VTE recurrences) in VTE patients who bled during the first 3 months of therapy, regarding the insertion of an IVC filter. A propensity score matched (PSM) analysis was performed to adjust for potential confounders. From January 2001 to September 2016, 1065 VTE patients had major bleeding during the first 3 months of anticoagulation (gastrointestinal 370; intracranial 124). Of these, 122 patients (11%) received an IVC filter. Patients receiving a filter restarted anticoagulation later (median, 4 vs. 2 days) and at lower doses (95 ± 52 IU/kg/day vs. 104 ± 55 of low-molecular-weight heparin) than those not receiving a filter. During the first 30 days after bleeding (after excluding 246 patients who died within the first 24 h), 283 patients (27%) died, 63 (5.9%) had non-fatal re-bleeding and 19 (1.8%) had recurrent pulmonary embolism (PE). In PSM analysis, patients receiving an IVC filter (n = 122) had a lower risk for all-cause death (HR 0.49; 95% CI 0.31–0.77) or fatal bleeding (HR 0.16; 95% CI 0.07–0.49) and a similar risk for re-bleeding (HR 0.55; 95% CI 0.23–1.40) or PE recurrences (HR 1.57; 95% CI 0.38–6.36) than those not receiving a filter (n = 429). In VTE patients experiencing major bleeding during the first 3 months, use of an IVC filter was associated with reduced mortality rates. Clinical Trial Registration NCT02832245.
Original languageEnglish
Pages (from-to)1101-1112
Number of pages12
JournalInternal and Emergency Medicine
Volume14
Issue number7
DOIs
Publication statusPublished - 1 Oct 2019

Keywords

  • Anticoagulants
  • Bleeding
  • MANAGEMENT
  • Mortality
  • OUTCOMES
  • PREVENTION
  • PULMONARY-EMBOLISM
  • RISK
  • THERAPY
  • Vena cava filter
  • Venous thromboembolism

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    Mellado, M., Trujillo-Santos, J., Bikdeli, B., Jiménez, D., Núñez, M. J., Ellis, M., Marchena, P. J., Vela, J. R., Clara, A., Moustafa, F., Monreal, M., Adarraga, M. D., Aibar, M. A., Alfonso, M., Arcelus, J. I., Ballaz, A., Baños, P., Barba, R., Barrón, M., ... Soler, S. (2019). Vena cava filters in patients presenting with major bleeding during anticoagulation for venous thromboembolism. Internal and Emergency Medicine, 14(7), 1101-1112. https://doi.org/10.1007/s11739-019-02077-5