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Vena Cava Filters and In-Hospital Case Fatality Among Patients With Pulmonary Embolism: Results From a Large Population-Based Study
In patients with venous thromboembolism (VTE), vena cava filters (VCFs) are currently only recommended when anticoagulant treatment is contraindicated or if VTE has recurred despite adequate anticoagulation. However, evidence on the efficacy of filter in patients with VTE is not compelling. We evalu...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019387/ https://www.ncbi.nlm.nih.gov/pubmed/31746216 http://dx.doi.org/10.1177/1076029619888022 |
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author | Pomero, Fulvio Ageno, Walter Dentali, Francesco Fenoglio, Luigi Squizzato, Alessandro Bonzini, Matteo |
author_facet | Pomero, Fulvio Ageno, Walter Dentali, Francesco Fenoglio, Luigi Squizzato, Alessandro Bonzini, Matteo |
author_sort | Pomero, Fulvio |
collection | PubMed |
description | In patients with venous thromboembolism (VTE), vena cava filters (VCFs) are currently only recommended when anticoagulant treatment is contraindicated or if VTE has recurred despite adequate anticoagulation. However, evidence on the efficacy of filter in patients with VTE is not compelling. We evaluated potential efficacy of VCF in reducing in-hospital mortality in a large population of patients presenting with a first episode of pulmonary embolism (PE). Patients were collected using regional hospital-discharge databases covering a population of more than 13 million of inhabitants in Northern Italy. For each year of observation, we calculated the proportion of cases with VCF among all PE incident cases. The temporal trend of VCF application during the study period was also derived. The effect of VCF use on in-hospital case-fatality rate was evaluated with a multivariate regression model and with the use of propensity score matching. During the study period (2002-2012), 60 813 patients were hospitalized for a first episode of acute PE. In-hospital case-fatality rate for PE was 13.3%. Vena cava filters were used in 745 (1.22%) patients. The annual use of VCF remained stable from 2002 to 2008, while it progressively decreased afterward. After adjustment for available confounders, case-fatality rate remained significantly lower in patients who received VCF compared to the one registered in patients who did not (odds ratio [OR] 0.46; 95% confidence interval [CI]: 0.34-0.62). Propensity score matching gave similar results (OR: 0.42; 95% CI: 0.30-0.61). Vena cava filters were infrequently used in patients with acute PE. Insertion of VCF appeared to sensibly reduce all-cause in-hospital mortality in this subgroup of patients. |
format | Online Article Text |
id | pubmed-7019387 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-70193872020-02-27 Vena Cava Filters and In-Hospital Case Fatality Among Patients With Pulmonary Embolism: Results From a Large Population-Based Study Pomero, Fulvio Ageno, Walter Dentali, Francesco Fenoglio, Luigi Squizzato, Alessandro Bonzini, Matteo Clin Appl Thromb Hemost Original Article In patients with venous thromboembolism (VTE), vena cava filters (VCFs) are currently only recommended when anticoagulant treatment is contraindicated or if VTE has recurred despite adequate anticoagulation. However, evidence on the efficacy of filter in patients with VTE is not compelling. We evaluated potential efficacy of VCF in reducing in-hospital mortality in a large population of patients presenting with a first episode of pulmonary embolism (PE). Patients were collected using regional hospital-discharge databases covering a population of more than 13 million of inhabitants in Northern Italy. For each year of observation, we calculated the proportion of cases with VCF among all PE incident cases. The temporal trend of VCF application during the study period was also derived. The effect of VCF use on in-hospital case-fatality rate was evaluated with a multivariate regression model and with the use of propensity score matching. During the study period (2002-2012), 60 813 patients were hospitalized for a first episode of acute PE. In-hospital case-fatality rate for PE was 13.3%. Vena cava filters were used in 745 (1.22%) patients. The annual use of VCF remained stable from 2002 to 2008, while it progressively decreased afterward. After adjustment for available confounders, case-fatality rate remained significantly lower in patients who received VCF compared to the one registered in patients who did not (odds ratio [OR] 0.46; 95% confidence interval [CI]: 0.34-0.62). Propensity score matching gave similar results (OR: 0.42; 95% CI: 0.30-0.61). Vena cava filters were infrequently used in patients with acute PE. Insertion of VCF appeared to sensibly reduce all-cause in-hospital mortality in this subgroup of patients. SAGE Publications 2019-11-20 /pmc/articles/PMC7019387/ /pubmed/31746216 http://dx.doi.org/10.1177/1076029619888022 Text en © The Author(s) 2019 http://creativecommons.org/licenses/by-nc/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Original Article Pomero, Fulvio Ageno, Walter Dentali, Francesco Fenoglio, Luigi Squizzato, Alessandro Bonzini, Matteo Vena Cava Filters and In-Hospital Case Fatality Among Patients With Pulmonary Embolism: Results From a Large Population-Based Study |
title | Vena Cava Filters and In-Hospital Case Fatality Among Patients With Pulmonary
Embolism: Results From a Large Population-Based Study |
title_full | Vena Cava Filters and In-Hospital Case Fatality Among Patients With Pulmonary
Embolism: Results From a Large Population-Based Study |
title_fullStr | Vena Cava Filters and In-Hospital Case Fatality Among Patients With Pulmonary
Embolism: Results From a Large Population-Based Study |
title_full_unstemmed | Vena Cava Filters and In-Hospital Case Fatality Among Patients With Pulmonary
Embolism: Results From a Large Population-Based Study |
title_short | Vena Cava Filters and In-Hospital Case Fatality Among Patients With Pulmonary
Embolism: Results From a Large Population-Based Study |
title_sort | vena cava filters and in-hospital case fatality among patients with pulmonary
embolism: results from a large population-based study |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7019387/ https://www.ncbi.nlm.nih.gov/pubmed/31746216 http://dx.doi.org/10.1177/1076029619888022 |
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