Thrombolytic therapy with or without a vena cava filter results in a lower case fatality rate in unstable patients with acute pulmonary embolism

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.

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Case Fatality Rate with Pulmonary Embolectomy for Acute Pulmonary Embolism

The American Journal of Medicine ◽

10.1016/j.amjmed.2011.12.003 ◽

2012 ◽

Vol 125 (5) ◽

pp. 471-477 ◽

Cited By ~ 38

Author(s):

Paul D. Stein ◽

Fadi Matta

Keyword(s):

Pulmonary Embolism ◽

Case Fatality Rate ◽

Acute Pulmonary Embolism ◽

Case Fatality ◽

Fatality Rate ◽

Pulmonary Embolectomy

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Vena cava filters in hospitalised patients with chronic obstructive pulmonary disease and pulmonary embolism

Thrombosis and Haemostasis ◽

10.1160/th13-01-0006 ◽

2013 ◽

Vol 109 (05) ◽

pp. 897-900 ◽

Cited By ~ 13

Author(s):

Fadi Matta ◽

Paul D. Stein

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Embolism ◽

Pulmonary Disease ◽

Case Fatality Rate ◽

Vena Cava ◽

Case Fatality ◽

Chronic Obstructive ◽

Fatality Rate ◽

Obstructive Pulmonary Disease ◽

Vena Cava Filters

SummaryIn view of the high case fatality rates of patients with chronic obstructive pulmonary disease (COPD) who have pulmonary embolism (PE) we speculated that such patients might benefit from vena cava filters. To test this hypothesis we assessed the database of the Nationwide Inpatient Sample. From 1998–2009, 440,370 patients were hospitalised with PE and COPD who were not in shock or ventilator-dependent and did not receive thrombolytic therapy or pulmonary embolectomy. In-hospital all-cause case fatality rate among those with filters was 5,890 of 68,800 (8.6%) (95% confidence interval [CI] = 8.4–8.8) compared with 38,960 of 371,570 (10.5%) (95% CI = 10.4–10.6) (p<0.0001) who did not receive filters. Case fatality rate was age-dependent. Only those who were older than aged 50 years had a lower in-hospital all-cause case fatality rate with filters. Among such patients, absolute risk reduction was 2.1% (95% CI = 1.9–2.3). The greatest reduction of case fatality rate with vena cava filters was shown in patients >aged 80 years, 11,720 of 81,600 (14.4%) compared with 1,570 of 17,220 (9.1%) (p<0.0001). In conclusion, a somewhat lower in-hospital all-cause case fatality rate was shown with vena filters in stable patients with PE >aged 50 years who also had COPD. The benefit was greatest in elderly patients. The benefit in terms of a decreased case fatality rate would seem to outweigh the risks of vena cava filters in such patients.

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