Vena cava filters in patients presenting with major bleeding during anticoagulation for venous thromboembolism

The RIETE Investigators

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

The association between inferior vena cava filter (IVC) use and outcome in patients presenting with major bleeding during anticoagulation for venous thromboembolism (VTE) has not been thoroughly investigated. We used the RIETE registry to compare the 30-day outcomes (death, major re-bleeding or VTE recurrences) in VTE patients who bled during the first 3 months of therapy, regarding the insertion of an IVC filter. A propensity score matched (PSM) analysis was performed to adjust for potential confounders. From January 2001 to September 2016, 1065 VTE patients had major bleeding during the first 3 months of anticoagulation (gastrointestinal 370; intracranial 124). Of these, 122 patients (11%) received an IVC filter. Patients receiving a filter restarted anticoagulation later (median, 4 vs. 2 days) and at lower doses (95 ± 52 IU/kg/day vs. 104 ± 55 of low-molecular-weight heparin) than those not receiving a filter. During the first 30 days after bleeding (after excluding 246 patients who died within the first 24 h), 283 patients (27%) died, 63 (5.9%) had non-fatal re-bleeding and 19 (1.8%) had recurrent pulmonary embolism (PE). In PSM analysis, patients receiving an IVC filter (n = 122) had a lower risk for all-cause death (HR 0.49; 95% CI 0.31–0.77) or fatal bleeding (HR 0.16; 95% CI 0.07–0.49) and a similar risk for re-bleeding (HR 0.55; 95% CI 0.23–1.40) or PE recurrences (HR 1.57; 95% CI 0.38–6.36) than those not receiving a filter (n = 429). In VTE patients experiencing major bleeding during the first 3 months, use of an IVC filter was associated with reduced mortality rates. Clinical Trial Registration NCT02832245.

Original languageEnglish
JournalInternal and Emergency Medicine
DOIs
Publication statusPublished - Jan 1 2019

Fingerprint

Vena Cava Filters
Venous Thromboembolism
Hemorrhage
Propensity Score
Pulmonary Embolism
Recurrence
Low Molecular Weight Heparin
Registries
Cause of Death
Clinical Trials

Keywords

  • Anticoagulants
  • Bleeding
  • Mortality
  • Vena cava filter
  • Venous thromboembolism

ASJC Scopus subject areas

  • Internal Medicine
  • Emergency Medicine

Cite this

Vena cava filters in patients presenting with major bleeding during anticoagulation for venous thromboembolism. / The RIETE Investigators.

In: Internal and Emergency Medicine, 01.01.2019.

Research output: Contribution to journalArticle

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title = "Vena cava filters in patients presenting with major bleeding during anticoagulation for venous thromboembolism",
abstract = "The association between inferior vena cava filter (IVC) use and outcome in patients presenting with major bleeding during anticoagulation for venous thromboembolism (VTE) has not been thoroughly investigated. We used the RIETE registry to compare the 30-day outcomes (death, major re-bleeding or VTE recurrences) in VTE patients who bled during the first 3 months of therapy, regarding the insertion of an IVC filter. A propensity score matched (PSM) analysis was performed to adjust for potential confounders. From January 2001 to September 2016, 1065 VTE patients had major bleeding during the first 3 months of anticoagulation (gastrointestinal 370; intracranial 124). Of these, 122 patients (11{\%}) received an IVC filter. Patients receiving a filter restarted anticoagulation later (median, 4 vs. 2 days) and at lower doses (95 ± 52 IU/kg/day vs. 104 ± 55 of low-molecular-weight heparin) than those not receiving a filter. During the first 30 days after bleeding (after excluding 246 patients who died within the first 24 h), 283 patients (27{\%}) died, 63 (5.9{\%}) had non-fatal re-bleeding and 19 (1.8{\%}) had recurrent pulmonary embolism (PE). In PSM analysis, patients receiving an IVC filter (n = 122) had a lower risk for all-cause death (HR 0.49; 95{\%} CI 0.31–0.77) or fatal bleeding (HR 0.16; 95{\%} CI 0.07–0.49) and a similar risk for re-bleeding (HR 0.55; 95{\%} CI 0.23–1.40) or PE recurrences (HR 1.57; 95{\%} CI 0.38–6.36) than those not receiving a filter (n = 429). In VTE patients experiencing major bleeding during the first 3 months, use of an IVC filter was associated with reduced mortality rates. Clinical Trial Registration NCT02832245.",
keywords = "Anticoagulants, Bleeding, Mortality, Vena cava filter, Venous thromboembolism",
author = "{The RIETE Investigators} and Meritxell Mellado and Javier Trujillo-Santos and Behnood Bikdeli and David Jim{\'e}nez and N{\'u}{\~n}ez, {Manuel Jes{\'u}s} and Martin Ellis and Marchena, {Pablo Javier} and Vela, {Jer{\'o}nimo Ram{\'o}n} and Albert Clara and Far{\`e}s Moustafa and Manuel Monreal and Adarraga, {M. D.} and Aibar, {M. A.} and M. Alfonso and Arcelus, {J. I.} and A. Ballaz and P. Ba{\~n}os and R. Barba and M. Barr{\'o}n and J. Bascu{\~n}ana and A. Blanco-Molina and Camon, {A. M.} and C. Carrasco and L. Chasco and Cruzs, {A. J.} and {del Pozo}, R. and {del Toro}, J. and D{\'i}az-Pedroche, {M. C.} and D{\'i}az-Peromingo, {J. A.} and M. Encabo and C. Falg{\'a} and C. Fern{\'a}ndez-Aracil and C. Fern{\'a}ndez-Capit{\'a}n and Fidalgo, {M. A.} and C. Font and L. Font and I. Furest and Garc{\'i}a, {M. A.} and F. Garc{\'i}a-Bragado and M. Garc{\'i}a-Morillo and A. Garc{\'i}a-Raso and I. Garc{\'i}a-S{\'a}nchez and O. Gav{\'i}n and C. G{\'o}mez and V. G{\'o}mez and J. Gonz{\'a}lez and E. Grau and A. Lorenzo and G. Antonucci and E. Grandone",
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AU - The RIETE Investigators

AU - Mellado, Meritxell

AU - Trujillo-Santos, Javier

AU - Bikdeli, Behnood

AU - Jiménez, David

AU - Núñez, Manuel Jesús

AU - Ellis, Martin

AU - Marchena, Pablo Javier

AU - Vela, Jerónimo Ramón

AU - Clara, Albert

AU - Moustafa, Farès

AU - Monreal, Manuel

AU - Adarraga, M. D.

AU - Aibar, M. A.

AU - Alfonso, M.

AU - Arcelus, J. I.

AU - Ballaz, A.

AU - Baños, P.

AU - Barba, R.

AU - Barrón, M.

AU - Bascuñana, J.

AU - Blanco-Molina, A.

AU - Camon, A. M.

AU - Carrasco, C.

AU - Chasco, L.

AU - Cruzs, A. J.

AU - del Pozo, R.

AU - del Toro, J.

AU - Díaz-Pedroche, M. C.

AU - Díaz-Peromingo, J. A.

AU - Encabo, M.

AU - Falgá, C.

AU - Fernández-Aracil, C.

AU - Fernández-Capitán, C.

AU - Fidalgo, M. A.

AU - Font, C.

AU - Font, L.

AU - Furest, I.

AU - García, M. A.

AU - García-Bragado, F.

AU - García-Morillo, M.

AU - García-Raso, A.

AU - García-Sánchez, I.

AU - Gavín, O.

AU - Gómez, C.

AU - Gómez, V.

AU - González, J.

AU - Grau, E.

AU - Lorenzo, A.

AU - Antonucci, G.

AU - Grandone, E.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - The association between inferior vena cava filter (IVC) use and outcome in patients presenting with major bleeding during anticoagulation for venous thromboembolism (VTE) has not been thoroughly investigated. We used the RIETE registry to compare the 30-day outcomes (death, major re-bleeding or VTE recurrences) in VTE patients who bled during the first 3 months of therapy, regarding the insertion of an IVC filter. A propensity score matched (PSM) analysis was performed to adjust for potential confounders. From January 2001 to September 2016, 1065 VTE patients had major bleeding during the first 3 months of anticoagulation (gastrointestinal 370; intracranial 124). Of these, 122 patients (11%) received an IVC filter. Patients receiving a filter restarted anticoagulation later (median, 4 vs. 2 days) and at lower doses (95 ± 52 IU/kg/day vs. 104 ± 55 of low-molecular-weight heparin) than those not receiving a filter. During the first 30 days after bleeding (after excluding 246 patients who died within the first 24 h), 283 patients (27%) died, 63 (5.9%) had non-fatal re-bleeding and 19 (1.8%) had recurrent pulmonary embolism (PE). In PSM analysis, patients receiving an IVC filter (n = 122) had a lower risk for all-cause death (HR 0.49; 95% CI 0.31–0.77) or fatal bleeding (HR 0.16; 95% CI 0.07–0.49) and a similar risk for re-bleeding (HR 0.55; 95% CI 0.23–1.40) or PE recurrences (HR 1.57; 95% CI 0.38–6.36) than those not receiving a filter (n = 429). In VTE patients experiencing major bleeding during the first 3 months, use of an IVC filter was associated with reduced mortality rates. Clinical Trial Registration NCT02832245.

AB - The association between inferior vena cava filter (IVC) use and outcome in patients presenting with major bleeding during anticoagulation for venous thromboembolism (VTE) has not been thoroughly investigated. We used the RIETE registry to compare the 30-day outcomes (death, major re-bleeding or VTE recurrences) in VTE patients who bled during the first 3 months of therapy, regarding the insertion of an IVC filter. A propensity score matched (PSM) analysis was performed to adjust for potential confounders. From January 2001 to September 2016, 1065 VTE patients had major bleeding during the first 3 months of anticoagulation (gastrointestinal 370; intracranial 124). Of these, 122 patients (11%) received an IVC filter. Patients receiving a filter restarted anticoagulation later (median, 4 vs. 2 days) and at lower doses (95 ± 52 IU/kg/day vs. 104 ± 55 of low-molecular-weight heparin) than those not receiving a filter. During the first 30 days after bleeding (after excluding 246 patients who died within the first 24 h), 283 patients (27%) died, 63 (5.9%) had non-fatal re-bleeding and 19 (1.8%) had recurrent pulmonary embolism (PE). In PSM analysis, patients receiving an IVC filter (n = 122) had a lower risk for all-cause death (HR 0.49; 95% CI 0.31–0.77) or fatal bleeding (HR 0.16; 95% CI 0.07–0.49) and a similar risk for re-bleeding (HR 0.55; 95% CI 0.23–1.40) or PE recurrences (HR 1.57; 95% CI 0.38–6.36) than those not receiving a filter (n = 429). In VTE patients experiencing major bleeding during the first 3 months, use of an IVC filter was associated with reduced mortality rates. Clinical Trial Registration NCT02832245.

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KW - Mortality

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KW - Venous thromboembolism

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