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. Bascuñana; A. 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

doi:10.1007/s11739-019-02077-5

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 language	English
Pages (from-to)	1101-1112
Number of pages	12
Journal	Internal and Emergency Medicine
Volume	14
Issue number	7
DOIs	https://doi.org/10.1007/s11739-019-02077-5
Publication status	Published - 1 Oct 2019

Keywords

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

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10.1007/s11739-019-02077-5

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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

@article{ed91096610c3495682031d36f6164220,

title = "Vena cava filters in patients presenting with major bleeding during anticoagulation for venous thromboembolism",

abstract = "{\textcopyright} 2019, Societ{\`a} 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.",

keywords = "Anticoagulants, Bleeding, MANAGEMENT, Mortality, OUTCOMES, PREVENTION, PULMONARY-EMBOLISM, RISK, THERAPY, Vena cava filter, Venous thromboembolism",

author = "Meritxell Mellado and Javier Trujillo-Santos and Behnood Bikdeli and David Jim{\'e}nez and N{\'u}{\~n}ez, {Manuel Jes{\'u}s} and Martin Ellis and Marchena, {Pablo Javier} and Vela, {Jer{\'o}nimo Ram{\'o}n} and Albert Clara and Far{\`e}s Moustafa and Manuel Monreal and Adarraga, {M. D.} and Aibar, {M. A.} and M. Alfonso and Arcelus, {J. I.} and A. Ballaz and P. Ba{\~n}os and R. Barba and M. Barr{\'o}n and J. Bascu{\~n}ana and A. Blanco-Molina and Camon, {A. M.} and C. Carrasco and L. Chasco and Cruzs, {A. J.} and {del Pozo}, R. and {del Toro}, J. and D{\'i}az-Pedroche, {M. C.} and D{\'i}az-Peromingo, {J. A.} and M. Encabo and C. Falg{\'a} and C. Fern{\'a}ndez-Aracil and C. Fern{\'a}ndez-Capit{\'a}n and Fidalgo, {M. A.} and C. Font and L. Font and I. Furest and Garc{\'i}a, {M. A.} and F. Garc{\'i}a-Bragado and M. Garc{\'i}a-Morillo and A. Garc{\'i}a-Raso and I. Garc{\'i}a-S{\'a}nchez and O. Gav{\'i}n and C. G{\'o}mez and V. G{\'o}mez and J. Gonz{\'a}lez and E. Grau and R. Guijarro and L. Guirado and J. Guti{\'e}rrez and L. Hern{\'a}ndez-Blasco and E. Hernando and V. Isern and L. Jara-Palomares and Jaras, {M. J.} and David Jim{\'e}nez and Joya, {M. D.} and J. Lima and P. Llamas and Lobo, {J. L.} and L. L{\'o}pez-Jim{\'e}nez and R. L{\'o}pez-Reyes and L{\'o}pez-S{\'a}ez, {J. B.} and Lorente, {M. A.} and A. Lorenzo and M. Loring and M. Lumbierres and O. Madridano and A. Maestre and Marchena, {P. J.} and M. Mart{\'i}n and F. Mart{\'i}n-Martos and Meritxell Mellado and M. Monreal and Morales, {M. V.} and Nieto, {J. A.} and N{\'u}{\~n}ez, {M. J.} and Olivares, {M. C.} and S. Otalora and R. Otero and Pedrajas, {J. M.} and G. Pellejero and C. P{\'e}rez-Ductor and Peris, {M. L.} and I. Pons and Porras, {J. A.} and A. Riera-Mestre and A. Rivas and Rodr{\'i}guez-D{\'a}vila, {M. A.} and I. Rodr{\'i}guez-Gal{\'a}n and V. Rosa and Rubio, {C. M.} and P. Ruiz-Artacho and Sahuquillo, {J. C.} and Sala-Sainz, {M. C.} and A. Samp{\'e}riz and B. S{\'a}nchez-Artola and R. S{\'a}nchez-Mart{\'i}nez and T. Sancho and S. Soler",

year = "2019",

month = oct,

day = "1",

doi = "10.1007/s11739-019-02077-5",

language = "English",

volume = "14",

pages = "1101--1112",

journal = "Internal and Emergency Medicine",

issn = "1828-0447",

number = "7",

}

Mellado, M, Trujillo-Santos, J, Bikdeli, B, Jiménez, D, Núñez, MJ, Ellis, M, Marchena, PJ, Vela, JR, Clara, A, Moustafa, F, Monreal, M, Adarraga, MD, Aibar, MA, Alfonso, M, Arcelus, JI, Ballaz, A, Baños, P, Barba, R, Barrón, M, Bascuñana, J, Blanco-Molina, A, Camon, AM, Carrasco, C, Chasco, L, Cruzs, AJ, del Pozo, R, del Toro, J, Díaz-Pedroche, MC, Díaz-Peromingo, JA, Encabo, M, Falgá, C, Fernández-Aracil, C, Fernández-Capitán, C, Fidalgo, MA, Font, C, Font, L, Furest, I, García, MA, García-Bragado, F, García-Morillo, M, García-Raso, A, García-Sánchez, I, Gavín, O, Gómez, C, Gómez, V, González, J, Grau, E, Guijarro, R, Guirado, L, Gutiérrez, J, Hernández-Blasco, L, Hernando, E, Isern, V, Jara-Palomares, L, Jaras, MJ, Jiménez, D, Joya, MD, Lima, J, Llamas, P, Lobo, JL, López-Jiménez, L, López-Reyes, R, López-Sáez, JB, Lorente, MA, Lorenzo, A, Loring, M, Lumbierres, M, Madridano, O, Maestre, A, Marchena, PJ, Martín, M, Martín-Martos, F, Mellado, M, Monreal, M, Morales, MV, Nieto, JA, Núñez, MJ, Olivares, MC, Otalora, S, Otero, R, Pedrajas, JM, Pellejero, G, Pérez-Ductor, C, Peris, ML, Pons, I, Porras, JA, Riera-Mestre, A, Rivas, A, Rodríguez-Dávila, MA, Rodríguez-Galán, I, Rosa, V, Rubio, CM, Ruiz-Artacho, P, Sahuquillo, JC, Sala-Sainz, MC, Sampériz, A, Sánchez-Artola, B, Sánchez-Martínez, R, Sancho, T & Soler, S 2019, 'Vena cava filters in patients presenting with major bleeding during anticoagulation for venous thromboembolism', Internal and Emergency Medicine, vol. 14, no. 7, pp. 1101-1112. https://doi.org/10.1007/s11739-019-02077-5

TY - JOUR

T1 - Vena cava filters in patients presenting with major bleeding during anticoagulation for venous thromboembolism

AU - Mellado, Meritxell

AU - Trujillo-Santos, Javier

AU - Bikdeli, Behnood

AU - Jiménez, David

AU - Núñez, Manuel Jesús

AU - Ellis, Martin

AU - Marchena, Pablo Javier

AU - Vela, Jerónimo Ramón

AU - Clara, Albert

AU - Moustafa, Farès

AU - Monreal, Manuel

AU - Adarraga, M. D.

AU - Aibar, M. A.

AU - Alfonso, M.

AU - Arcelus, J. I.

AU - Ballaz, A.

AU - Baños, P.

AU - Barba, R.

AU - Barrón, M.

AU - Bascuñana, J.

AU - Blanco-Molina, A.

AU - Camon, A. M.

AU - Carrasco, C.

AU - Chasco, L.

AU - Cruzs, A. J.

AU - del Pozo, R.

AU - del Toro, J.

AU - Díaz-Pedroche, M. C.

AU - Díaz-Peromingo, J. A.

AU - Encabo, M.

AU - Falgá, C.

AU - Fernández-Aracil, C.

AU - Fernández-Capitán, C.

AU - Fidalgo, M. A.

AU - Font, C.

AU - Font, L.

AU - Furest, I.

AU - García, M. A.

AU - García-Bragado, F.

AU - García-Morillo, M.

AU - García-Raso, A.

AU - García-Sánchez, I.

AU - Gavín, O.

AU - Gómez, C.

AU - Gómez, V.

AU - González, J.

AU - Grau, E.

AU - Guijarro, R.

AU - Guirado, L.

AU - Gutiérrez, J.

AU - Hernández-Blasco, L.

AU - Hernando, E.

AU - Isern, V.

AU - Jara-Palomares, L.

AU - Jaras, M. J.

AU - Jiménez, David

AU - Joya, M. D.

AU - Lima, J.

AU - Llamas, P.

AU - Lobo, J. L.

AU - López-Jiménez, L.

AU - López-Reyes, R.

AU - López-Sáez, J. B.

AU - Lorente, M. A.

AU - Lorenzo, A.

AU - Loring, M.

AU - Lumbierres, M.

AU - Madridano, O.

AU - Maestre, A.

AU - Marchena, P. J.

AU - Martín, M.

AU - Martín-Martos, F.

AU - Mellado, Meritxell

AU - Monreal, M.

AU - Morales, M. V.

AU - Nieto, J. A.

AU - Núñez, M. J.

AU - Olivares, M. C.

AU - Otalora, S.

AU - Otero, R.

AU - Pedrajas, J. M.

AU - Pellejero, G.

AU - Pérez-Ductor, C.

AU - Peris, M. L.

AU - Pons, I.

AU - Porras, J. A.

AU - Riera-Mestre, A.

AU - Rivas, A.

AU - Rodríguez-Dávila, M. A.

AU - Rodríguez-Galán, I.

AU - Rosa, V.

AU - Rubio, C. M.

AU - Ruiz-Artacho, P.

AU - Sahuquillo, J. C.

AU - Sala-Sainz, M. C.

AU - Sampériz, A.

AU - Sánchez-Artola, B.

AU - Sánchez-Martínez, R.

AU - Sancho, T.

AU - Soler, S.

PY - 2019/10/1

Y1 - 2019/10/1

N2 - © 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.

AB - © 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.

KW - Anticoagulants

KW - Bleeding

KW - MANAGEMENT

KW - Mortality

KW - OUTCOMES

KW - PREVENTION

KW - PULMONARY-EMBOLISM

KW - RISK

KW - THERAPY

KW - Vena cava filter

KW - Venous thromboembolism

UR - http://www.mendeley.com/research/vena-cava-filters-patients-presenting-major-bleeding-during-anticoagulation-venous-thromboembolism

U2 - 10.1007/s11739-019-02077-5

DO - 10.1007/s11739-019-02077-5

M3 - Article

C2 - 31054013

SN - 1828-0447

VL - 14

SP - 1101

EP - 1112

JO - Internal and Emergency Medicine

JF - Internal and Emergency Medicine

IS - 7

ER -

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

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