CLINICAL NEWS
Literature Scan
New and noteworthy research from the
medical literature landscape
Vena Cava Filters Not Worth the Risk in
Patients with Acute Pulmonary Embolism
Receiving Anticoagulation
Over the past three decades, inferior vena cava (IVC) filters have
been used much more frequently
as an add-on to anticoagulation
therapy in patients with pulmonary embolism (PE), despite the
lack of reliable evidence about the
risk-benefit ratio of these filters.
According to a recent report
published in JAMA, adding a
retrievable IVC filter to anticoagulation offered no significant benefit
compared with anticoagulation
alone – suggesting that these types
of filters are not worth the excess
risk for patients who can receive
anticoagulation alone.
Prior randomized studies in
patients with proximal deep-vein
thrombosis (DVT), with or without PE, have shown a significant
reduction in recurrent PE when
IVC filters were employed as an
add-on to anticoagulation – but
this reduction was coupled with
more delayed recurrences, filter
thrombosis, and no all-cause mortality advantage. In the randomized, open-label, blinded endpoint
PREPIC2 trial, Patrick Mismetti,
MD, PhD, of the Centre Hospitalier Universitaire de Saint-Étienne
in France, and investigators sought
“[The results] do
not support the
use of this type
of IVC filter in
patients who
can be treated
with anticoagulation.”
—PATRICK MISMETTI, MD, PhD
40
ASH Clinical News
to determine if a retrievable IVC
filter would provide the same benefit but without these late adverse
events.
Patients hospitalized with
acute, symptomatic PE associated
with lower limb-vein thrombosis
and at least one criterion for severity were enrolled in the PREPIC2
trial and followed for six months.
These high-risk features included:
age >75 years, active cancer,
chronic cardiac or respiratory
insufficiency, ischemic stroke with
leg paralysis in the last six months.
DVT that involved the iliocaval
segment or was bilateral, and at
least one sign of right ventricular
dysfunction or myocardial injury.
Two-hundred patients were
randomized to receive retrievable IVC filter implantation plus
anticoagulation (n=200), and
199 patients were randomized to
receive anticoagulation alone (the
study’s control group).
The study’s primary endpoint
was sym F