Lin Jules, Proctor Mary C, Varma Manu, Greenfield Lazar J, Upchurch Gilbert R, Henke Peter K
Department of Surgery, Section of Vascular Surgery, University of Michigan, Ann Arbor, USA.
J Vasc Surg. 2003 May;37(5):976-83. doi: 10.1067/mva.2003.191.
The role of prophylactic vena cava filters (VCF) in patients with cancer is debated. Although VCF are often placed in patients with cancer after recurrence of venous thromboembolic events (VTE), identification of this subset of patients has not been well-defined. This study was undertaken to assess factors associated with increased risk for recurrent VTE.
All patients with a history of thromboembolism or malignant disease and who required a VCF because of failure of or contraindication to anticoagulation therapy were abstracted from the Michigan Filter Registry. Univariate analysis of potential risk factors for recurrent VTE and logistic regression models were used to identify associations between these variables and recurrent VTE.
Ninety-nine patients (49 men, 50 women) with a mean age of 58 years were included in the study. New metastases occurred in 55% of patients, and 12% of patients had a history of VTE before cancer diagnosis. Corticosteroid agents were used during therapy in 48% of patients. Acute VTE was present in 52% of patients at cancer diagnosis, and in 34% of patients VTE was associated with new metastases. Recurrent VTE occurred in 40% of patients, and significant risk factors included presence of new metastases (odds ratio [OR], 3.3; 95% confidence interval [CI], 1.16-9.09; P =.02) and history of VTE (OR, 10.6; CI, 1.98-57.2; P =.006). Whereas a single episode of neutropenia did not reach significance (OR, 1.1; CI, 0.97-1.35; P =.11), multiple neutropenic episodes were significantly associated with recurrent VTE (P =.04). Smoking, hormone replacement therapy, decreased mobility, post-surgical state, and obesity were not independently associated with increased risk. Mean survival in this series was 30 months, and was significantly worse in patients with VTE at cancer diagnosis and with inability to tolerate anticoagulant therapy in conjunction with VCF.
Patients with malignant disease may be at increased risk for recurrent VTE after development of new metastases or multiple episodes of neutropenia, especially those patients with a history of VTE. VCF may be a reasonable alternative to long-term anticoagulation therapy in this subgroup of patients at high risk patients, provided their quality of life is reasonable.
预防性腔静脉滤器（VCF）在癌症患者中的作用存在争议。尽管VCF常用于静脉血栓栓塞事件（VTE）复发后的癌症患者，但这部分患者的识别尚未明确界定。本研究旨在评估与复发性VTE风险增加相关的因素。
从密歇根滤器登记处提取所有有血栓栓塞或恶性疾病病史且因抗凝治疗失败或禁忌而需要VCF的患者。对复发性VTE的潜在危险因素进行单因素分析，并使用逻辑回归模型确定这些变量与复发性VTE之间的关联。
99例患者（49例男性，50例女性）纳入研究，平均年龄58岁。55%的患者出现新的转移灶，12%的患者在癌症诊断前有VTE病史。48%的患者在治疗期间使用了皮质类固醇药物。52%的患者在癌症诊断时存在急性VTE，34%的患者VTE与新的转移灶相关。40%的患者发生复发性VTE，显著的危险因素包括新转移灶的存在（比值比[OR]，3.3；95%置信区间[CI]，1.16 - 9.09；P = 0.02）和VTE病史（OR，10.6；CI，1.98 - 57.2；P = 0.006）。而单次中性粒细胞减少发作未达到显著水平（OR，1.1；CI，0.97 - 1.35；P = 0.11），多次中性粒细胞减少发作与复发性VTE显著相关（P = 0.04）。吸烟、激素替代疗法、活动能力下降、术后状态和肥胖与风险增加无独立关联。本系列患者的平均生存期为30个月，在癌症诊断时伴有VTE且无法耐受抗凝治疗联合VCF的患者中生存期明显更差。
恶性疾病患者在出现新的转移灶或多次中性粒细胞减少发作后，尤其是有VTE病史的患者，复发性VTE风险可能增加。对于这一高危亚组患者，如果生活质量尚可，VCF可能是长期抗凝治疗的合理替代方案。
