Vena cava filters in patients presenting with major bleeding during anticoagulation for venous thromboembolism
- PDF / 1,369,366 Bytes
- 12 Pages / 595.276 x 790.866 pts Page_size
- 102 Downloads / 156 Views
IM - ORIGINAL
Vena cava filters in patients presenting with major bleeding during anticoagulation for venous thromboembolism Meritxell Mellado1 · Javier Trujillo‑Santos2 · Behnood Bikdeli3,4,5 · David Jiménez6 · Manuel Jesús Núñez7 · Martin Ellis8 · Pablo Javier Marchena9 · Jerónimo Ramón Vela10 · Albert Clara11 · Farès Moustafa12 · Manuel Monreal13 · The RIETE Investigators Received: 7 December 2018 / Accepted: 20 March 2019 © Società Italiana di Medicina Interna (SIMI) 2019
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 · Vena cava filter · Mortality · Venous thromboembolism.
Introduction Bleeding is the most feared complication in patients receiving anticoagulant therapy for venous thromboembolism (VTE). In the literature, the rate of fatal bleeding in VTE patients receiving anticoagulant therapy ranged around 0.5–1.0 deaths per 100 patient-years [1–3] Current management of patients with major bleeding usually starts with immediate discontinuation of anticoagulant therapy, followed by an intervention (endoscopy, coiling, surgery) and treatment with blood transfusion, vitamin A full list of RIETE investigators is given in the acknowledgements. * Manuel Monreal [email protected]
K, prothrombin complex concentrate, fresh frozen plasma, or insertion of a vena cava filter (IVC), based on the type and severity of the bleeding and local protocols and resources [4–9]. IVC filters have bee
Data Loading...
