This Article Full Text (PDF) All Versions of this Article: 1076029608315165v1 15/3/263    most recent References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Scopus Google Scholar Articles by Barginear, M. F. Articles by Budman, D. R. PubMed PubMed Citation Articles by Barginear, M. F. Articles by Budman, D. R. Pubmed/NCBI databases Medline Plus Health Information Blood Thinners Cancer Deep Vein Thrombosis Social Bookmarking                         What's this?

Need for Inferior Vena Cava Filters in Cancer Patients: A Surrogate Marker for Poor Outcome

Don Monti Division of Oncology, North Shore University Hospital

Martin Lesser, PhD

Biostatistics Unit, Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System MLA), Manhasset, New York

Meredith Lukin Akerman, MS

Biostatistics Unit, Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System MLA), Manhasset, New York

Marianna Strakhan, MD

Don Monti Division of Oncology, North Shore University Hospital

Iuliana Shapira, MD

Don Monti Division of Oncology, North Shore University Hospital

Thomas Bradley, MD

Don Monti Division of Oncology, North Shore University Hospital

Daniel R. Budman, MD

Don Monti Division of Oncology, North Shore University Hospital, DBudman{at}NSHS.edu

Background. Cancer patients have an increased incidence of venous thromboembolism (VTE). Inferior vena cava (IVC) filters are used extensively in the US, and more than 40 000 are inserted annually. The impact on survival of cancer patients receiving IVC filters has not been studied. Methods. A retrospective study examined 206 consecutive cancer patients with VTE to compare the effects of IVC filter placement with anticoagulation (AC) therapy on overall survival (OS), as measured from the time of VTE. Patients were classified into 3 treatment groups: AC (n = 62), IVC filter (77), or combination IVC filter + AC (67). Results. Treatment groups did not differ with respect to age, sex, or albumin levels. Median OS was significantly greater in patients treated with AC (13 months) compared with those treated with IVC filters (2 months) or IVC + AC (3.25 months; P < .0002). IVC patients were 1.9 times more at risk of death than AC only (hazard ratio = .528; 95% confidence interval = .374 to .745). Multivariate analysis revealed that performance status and type of thrombus were not confounders and had no effect on OS. Conclusion. The need for the insertion of an IVC filter projected markedly reduced survival. Patients requiring an IVC filter rather than AC as initial therapy face a 2-fold increase in risk of death. Whether or not this therapeutic procedure has a positive impact on outcome in cancer patients is uncertain. Complications resulting from thrombosis were also analyzed in this cohort. A prospective randomized trial at our institution is addressing this issue.

Key Words: IVC filter • thrombosis • cancer

This version was published on June 1, 2009

Clinical and Applied Thrombosis/Hemostasis, Vol. 15, No. 3, 263-269 (2009)
DOI: 10.1177/1076029608315165


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?