Abstract
Background
In view of the high risk of pulmonary embolism in patients with cancer, we tested
the hypothesis that stable patients with pulmonary embolism who have cancer might
be a subset of patients who would show a lower case fatality rate with vena cava filters
than without filters.
Methods
Stable patients with pulmonary embolism and cancer at discharge from short-stay hospitals
throughout the US from 1998-2009 were identified from the Nationwide Inpatient Sample.
Patients with pulmonary embolism who had a diagnostic code for shock, ventilatory
support, thrombolytic therapy, or pulmonary embolectomy were excluded because such
patients have been shown to have lower case fatality rate with filters.
Results
In-hospital all-cause case fatality rate was lower with vena cava filters in stable
patients with pulmonary embolism and solid malignant tumors providing they were aged
>30 years, but there was variability according to type of tumor and age of patient.
On average, case fatality rate among those >30 years with filters was 7070 of 69,350
(10.2%) (95% confidence interval, 10.0-10.4) versus 36,875 of 247,125 (14.9%) (95%
confidence interval, 14.8-15.1) without filters (P <.0001) (relative risk 0.68). Among stable patients with hematological malignancies,
case fatality rate, except in the elderly, was higher among those with vena cava filters than those without filters.
Conclusion
Stable patients with pulmonary embolism and solid malignant tumors who are older than
age 30 years appear to be a subset of patients with pulmonary embolism who would benefit
from vena cava filters, but this needs to be tested prospectively.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Impact of vena cava filters on in-hospital case fatality rate from pulmonary embolism.Am J Med. 2012; 125: 478-484
- Antithrombotic therapy for VTE disease: antithrombotic therapy for prevention of thrombosis, 9th ed. American College of Chest Physicians Evidence-Based Guidelines.Chest. 2012; 141: e419S-e494S
- Thrombosis and cancer.Semin Oncol. 2000; 27: 362-374
- Cancer and thrombosis.Haemostasis. 1994; 24: 128-131
- Incidence of venous thromboembolism in patients hospitalized with cancer.Am J Med. 2006; 119: 60-68
HCUP Nationwide Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP) 1998-2009. Rockville, MD: Agency for Healthcare Research and Quality. Available at: www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed January 20, 2013.
- Case fatality rate with pulmonary embolectomy for acute pulmonary embolism.Am J Med. 2012; 125: 471-477
- Inferior vena caval filters: review of a 26-year single-center clinical experience.Radiology. 2000; 216: 54-66
- The role of vena caval interruption in patients with venous thromboembolism.Prog Cardiovasc Dis. 1994; 37: 25-37
- Inferior vena cava filters in the management of cancer-associated venous thromboembolism: a systematic review.Oncol Rev. 2010; 4: 147-157
- Treatment of patients with venous thromboembolism and malignant disease: should vena cava filter placement be routine?.J Vasc Surg. 1998; 28: 800-807
- Inferior vena cava filter placement in late-stage cancer.Vasc Endovasc Surg. 2006; 40: 287-294
- Outcome and complications of retrievable inferior vena cava filters.Am J Cardiol. 2004; 94: 1090-1093
- Outcomes with retrievable inferior vena cava filters.J Invasive Cardiol. 2010; 22: 235-239
FDA Advisory, August 09, 2010. Removing retrievable inferior vena cava filters: initial communication. Available at: http://www.fda.gov/MedicalDevices/Safety/AltersandNotices/ucm221676.htm. Accessed January 25, 2013.
- Vena cava filters in hospitalized patients with chronic obstructive pulmonary disease and pulmonary embolism.Thromb Haemost. 2013; 109: 897-900
- A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. Prévention du Risque d'Embolie Pulmonaire par Interruption Cave Study Group.N Engl J Med. 1998; 338: 409-415
- Eight-year follow-up of patients with permanent vena cava filters in the prevention of pulmonary embolism: the PREPIC (Prevention du Risque d'Embolie Pulmonaire par Interruption Cave) randomized study.Circulation. 2005; 112: 416-422
- Venous thromboembolism discharge diagnoses in the Danish National Patient Registry should be used with caution.J Clin Epidemiol. 2010; 63: 223-228
- The epidemiology of diagnosed pulmonary embolism and deep venous thrombosis in the elderly.Arch Intern Med. 1994; 154: 861-866
Article info
Footnotes
Funding: None.
Conflict of Interest: None.
Authorship: All authors had access to the data and a role in writing the manuscript.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
