Contemporary Trends and Comparative Outcomes With Adjunctive Inferior Vena Cava Filter Placement in Patients Undergoing Catheter-Directed Thrombolysis for Deep Vein Thrombosis in the United States: Insights From the National Inpatient Sample.

Abstract

OBJECTIVES:

The aim of this study was to investigate the contemporary trends and comparative effectiveness of adjunctive inferior vena cava filter (IVCF) placement in patients undergoing catheter-directed thrombolysis (CDT) for treatment of proximal lower extremity or caval deep vein thrombosis.

BACKGROUND:

CDT is being increasingly used in the management of proximal deep vein thrombosis. Although a significant number of patients treated with CDT undergo adjunctive IVCF placement, the benefit of this practice remains unknown.

METHODS:

The National Inpatient Sample database was used to identify all patients with proximal or caval deep vein thrombosis who underwent CDT (with and without adjunctive IVCF placement) in the United States between January 2005 and December 2013. A propensity score-matching algorithm was then used to derive 2 matched groups of patients (IVCF and no IVCF) for comparative outcomes (mortality and major and minor bleeding) and resource use analysis.

RESULTS:

Of the 7,119 patients treated with CDT, 2,421 (34%) received IVCFs. There was no significant difference in in-hospital mortality (0.7% vs 1.0%; p = 0.20), procedure-related hemorrhage (1.4% vs. 1.0%; p = 0.23), or intracranial hemorrhage (0.7% vs. 0.6%; p = 0.70) between the IVCF (n = 2,259) and no-IVCF (n = 2,259) groups, respectively. Patients undergoing IVCF placement had higher rates of hematoma (3.4% vs 2.1%; p = 0.009), higher in-hospital charges ($104,049 ± 75,572 vs. $92,881 ± 80,194; p < 0.001) and increased length of stay (7.3 ± 5.6 days vs. 6.9 ± 6.9 days; p = 0.046) compared with the no-IVCF group.

CONCLUSIONS:

This nationwide observational study suggests that one-third of all patients undergoing CDT receive IVCFs. IVCF use was not associated with a decrease in in-hospital mortality but was associated with higher inpatient charges and longer length of stay.

• Authors: Othman S Akhtar, Vladimir Lakhter, Chad J Zack, Hafiz Hussain, Vikas Aggarwal, Estefania Oliveros, Yevgeniy Brailovsky, Huaqing Zhao, Ravi Dhanisetty, Resmi A Charalel, Matthew Zhao, Riyaz Bashir
• Journal: JACC. Cardiovascular interventions (JACC Cardiovasc Interv) Vol. 11 Issue 14 Pg. 1390-1397 (07 23 2018) ISSN: 1876-7605 [Electronic] United States
• PMID: 30025732 (Publication Type: Comparative Study, Journal Article, Observational Study)
• Copyright: Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Chemical References

• Fibrinolytic Agents

Topics

• Adult
• Aged
• Catheterization, Peripheral (adverse effects, mortality, trends)
• Comparative Effectiveness Research
• Databases, Factual
• Female
• Fibrinolytic Agents (administration & dosage, adverse effects)
• Hemorrhage (chemically induced)
• Hospital Charges (trends)
• Hospital Mortality (trends)
• Humans
• Inpatients
• Length of Stay (trends)
• Male
• Middle Aged
• Prosthesis Implantation (adverse effects, instrumentation, mortality, trends)
• Risk Factors
• Thrombolytic Therapy (adverse effects, mortality, trends)
• Time Factors
• Treatment Outcome
• United States (epidemiology)
• Vena Cava Filters (trends)
• Venous Thrombosis (diagnostic imaging, drug therapy, mortality)