Inferior Vena Cava interruption is a commonly applied therapeutic intervention in acute pulmonary thromboembolism. There is very little data on how IVC filters affect immediate patient outcome.
A review of case records of all patients admitted to a tertiary care teaching hospital over a three year period(1998-2000) was undertaken. To be included the patients must have a high probability V/Q scan, intermediate V/Q scan with positive lower exteremity doppler study, positive pulmonary angiogram.The primary outcome measured was all cause mortality during the hospital stay.
191 patients met criteria to be included in the study. Mean age was 65 years, with 88 males and 103 females. 54 patients had active malignancy and 21 patients received thrombolytics. 58 patients had inferior vena cava filters placed with or without anticoagulation. In patients who recieved thrombolytics all but one had IVC filter placed. There were no complications in the patients who were thrombolysed. All cause mortality in patients with acute PE was 22/191(11.5%). There were 19 deaths in patients who did not have IVC filters placed and 3 in those with IVC filters(p=0.697).
There was a trend towards decrease in all cause mortality in patients with acute pulmonary thromboembolism treated with IVC filters although this did not reach statistical significance.These results may be confounded by the fact that the patients who recieved thrombolytics did well.
In our single center data aggressive use of inferior vena cava filters in pulmonary thromboembolic disease was associated with a better short term outcome. Multicenter data may be needed to determine the clinical significance of this study. It may be unethical to do a randomized trial with IVC filters.
P. Grover, None.