Inferior vena cava filter placement in acute pulmonary embolism did not prevent recurrence, while late placement was associated with a 4-6 day median increase in ICU and hospital LOS (p<0.05).
Cohort (n=468)
No
Does inferior vena cava filter placement reduce PE recurrence and length of stay in patients with acute pulmonary embolism?
In a real-world cohort of acute PE patients, IVC filter placement did not improve recurrence rates or length of stay after adjusting for illness severity, reinforcing a selective and time-limited strategy.
p-value: p=<0.05
Abstract Rationale Inferior vena cava (IVC) filters remain a management option for acute pulmonary embolism (PE) when anticoagulation is contraindicated or as an adjunct to interventional therapy. Prior population-level studies, including those by Stein et al. using the National Inpatient Sample, suggested potential mortality reduction with early filter placement. However, contemporary real-world data in the era of catheter-directed therapy are limited. This study aimed to evaluate patterns, outcomes, and timing of IVC filter use across clinical PE phenotypes. Methods We retrospectively analyzed patients with acute PE from 2015-2024 at a tertiary PERT center, stratified into intermediate-risk PE (n = 298), elderly PE + DVT (n = 132), and high-risk PE requiring ECMO (n = 38). Variables included clot distribution (proximal vs distal), biomarkers (troponin, BNP/proBNP), echocardiographic findings (TAPSE, RVSP, McConnell sign), and comorbidities (cancer, COPD, CHF, CKD). Primary outcomes were PE recurrence (exploratory) and hospital/ICU length of stay (LOS); mortality was secondary. Filters were categorized as early (≤4 days) or late (4 days) from PE diagnosis. Multivariable logistic and linear models adjusted for procedural intervention, clot burden, RV strain, biomarker elevation, and comorbidity count. Results Across cohorts, 14-37 % of patients received an IVC filter; 58 % were placed within 4 days of diagnosis. Filter recipients were more likely to have proximal clot and biomarker elevation, indicating higher initial severity. After adjustment, filter placement (regardless of timing) was not independently associated with recurrence prevention or in-hospital outcomes. Late filter placement was associated with longer ICU and hospital LOS (median increase 4-6 days; p 0.05). In the elderly cohort, filters correlated with higher comorbidity burden and longer stays; in ECMO patients, outcomes were driven by underlying hemodynamic instability. The previously observed mortality reduction with early filters in prior national analysis was not replicated in this institutionally granular dataset. Conclusions In this multicohort real-world study, IVC filters were used selectively but did not confer measurable benefit in recurrence or LOS after adjustment for illness severity. Timing of placement reflected clinical acuity rather than efficacy, contrasting with the favorable early-placement signal reported by Stein et al. These results reinforce a selective, time-limited filter strategy—prioritizing clear indications, procedural coordination, and prompt retrieval once anticoagulation becomes feasible. This abstract is funded by: None
Martinez et al. (Fri,) conducted a cohort in Acute pulmonary embolism (n=468). Inferior vena cava (IVC) filter vs. No IVC filter / Early vs Late placement was evaluated on PE recurrence and hospital/ICU length of stay (LOS) (p=<0.05). Inferior vena cava filter placement in acute pulmonary embolism did not prevent recurrence, while late placement was associated with a 4-6 day median increase in ICU and hospital LOS (p<0.05).