Incident Venous Thromboembolism Following Inferior Vena Cava Filter Placement With And Without Subsequent Anticoagulation Use
Jacob Weber, MD, Marc Passman, MD, Zdenek Novak, MD, Benjamin Pearce, Graeme McFarland, MD, Danielle Sutzko, MD, Mark Patterson, MD, Adam Beck, MD, Emily Spangler, MD.
UAB, Birmingham, AL, USA.
Objectives:To examine rates of incident venous thromboembolism (VTE) at follow-up based on whether patients requiring inferior vena cava filters (IVCF) were also treated with anticoagulation. Methods:The Vascular Quality Initiative registry was used to identify all IVCF placed from 2013-20. Discharge anticoagulation regimens were categorized as none vs any. Patients with malignancy or lacking follow-up were excluded. Analyses were stratified by presence or absence of VTE at time of IVCF placement. Demographics, outcomes of incident VTE, mortality, and filter retrieval by last long term follow-up were evaluated. Categorical values were tested by χ 2 and mortality by Kaplan-Meier plots and log-rank testing. Results:Of 4,901 filters, most (70.8%) were placed for documented VTE. 2,587 (52.7%) were anticoagulated at discharge. Prophylactic filter patients without anticoagulation were more likely to be women (55.1% vs 48.4%, p=.013), non-white race (33.0% vs 27.0%, p=.017) or have ESRD (1.8% vs 0.4%, p=.014) than those anticoagulated. VTE patients without anticoagulation were more likely to be non-white race (31.2% vs 21.9%, p<0.001), smokers (49.5% vs 43.5%, p=.001), and have CAD (14.5% vs 9.4%, p<.001), HTN (70.1% vs 56.6%, p<.001), CHF (13.3% vs 8.9%, p<0.001), ESRD (3.3% vs 1.1%, p<.001) and impaired ambulation (32.5% vs 21.2%, p<.001) compared to anticoagulated patients. VTE patients discharged with anticoagulation had lower rates of incident VTE (3.8% vs. 5.5%, p=.015) and 1-year mortality (2.1% vs 6%, p<.001) and higher rates of filter retrieval (69.7% vs 30.3%, p<.001) compared to patients without anticoagulation. However, no differences were observed based on anticoagulation status in prophylactic filters. Comparing prophylactic filter patients with and without anticoagulation, similar rates of incident VTE (2.8% vs 3.3%, p=.604), 1-year mortality (1.6% vs 1.4%, p=.735), and filter retrieval (70.9% vs 75.9% p=.440) were seen respectively. Overall survival was higher (Figure) among VTE patients with anticoagulation versus those without, with no observed difference by anticoagulation status in prophylactic filters.Conclusion:Patients with documented VTE may have higher ongoing risk for subsequent VTE post IVCF placement. Subsequent use of anticoagulation after IVCF placement is associated with lower incident VTE rates in patients requiring IVCFs for documented VTE, but not for prophylaxis.
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