Key result
IVC filter placement in complicated PE is linked to ~37% lower mortality versus no filter.
Why the study?
Previous observational studies suggested a mortality benefit of IVC filters in PE complicated by congestive heart failure, mechanical ventilation, or shock, prompting analysis in patients complicated by AMI, acute respiratory failure, shock, or requiring thrombolytics.
Does inferior vena cava filter placement reduce mortality in complicated pulmonary embolism patients?
Observational (n=254,465)
Yes
Does inferior vena cava filter placement reduce mortality in complicated pulmonary embolism patients?
Number Needed to Treat: 8.28 (95% CI 7.91–8.69)
Absolute Event Rate: 20.9% vs 33%
Number Needed to Treat: 8.28
p-value: p=<0.001
In a large retrospective cohort of patients with complicated pulmonary embolism, inferior vena cava filter placement was associated with a significant reduction in mortality.
May support IVC filter use in complicated PE; leaves open confirmation of mortality benefit in randomized trials.
Background: Previous observational studies suggest that inferior vena cava filter placement in pulmonary embolism patients complicated with congestive heart failure, mechanical ventilation, and shock may have a mortality benefit. We sought to analyze the survival benefits of inferior vena cava filter in pulmonary embolism patients complicated with acute myocardial infarction, acute respiratory failure, shock, or requiring treatment with thrombolytics. Methods: This retrospective observational study used hospital discharge data from the National Inpatient Sample Data (NIS). ICD‐9‐CM coding was used to identify complicated pulmonary embolism patients (N = 254,465) in NIS from 2002 to 2014, including the subgroups of acute myocardial infarction, acute respiratory failure, shock, and thrombolytics. Inferior vena cava filter recipients were 1:1 propensity score‐matched on age, sex, race, deep vein thrombosis, Elixhauser comorbidities, and other pulmonary embolism comorbidities (45 covariates) to non‐inferior vena cava filter recipients in complicated pulmonary embolism patients and separately in each subgroup. Clinical outcomes were compared between the inferior vena cava filter group and the non‐inferior vena cava filter group. Results: Mortality rate in complicated pulmonary embolism patients with inferior vena cava filter placement was lower (20.9% vs. 33%; NNT = 8.28, 95% confidence interval (CI) 7.91–8.69, E‐value = 2.53) and in the subgroups; acute myocardial infarction (17.9% vs. 30.1%; NNT = 8.19, 95% CI 7.52–8.92, E‐value = 2.76), acute respiratory failure (19.5% vs. 29.7%; NNT = 9.76, 95% CI 8.67–11.16, E‐value = 2.38), shock (30.7% vs. 47.1%; NNT = 6.08, 95% CI 5.73–6.47, E‐value = 2.43), and with the use of thrombolytics (7% vs. 12.9 %; NNT 17.1, 95% CI 14.88–20.12, E‐value = 3.01) (p < 0.001 for all). Conclusion: Inferior vena cava filter placement in pulmonary embolism complicated with acute myocardial infarction, acute respiratory failure, shock, or requiring thrombolytic therapy was associated with reduced mortality.
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Gul et al. (2019) conducted an observational in Complicated pulmonary embolism (n=254,465). Inferior vena cava filter placement vs. Non-inferior vena cava filter recipients was evaluated on Mortality rate (NNT 8.28, 95% CI 7.91-8.69, p=<0.001). Inferior vena cava filter placement in complicated pulmonary embolism was associated with lower mortality compared to no filter (20.9% vs. 33%; NNT 8.28, 95% CI 7.91-8.69; p<0.001).
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