Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan; Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Japan.
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan.
Am J Med. 2015 Mar;128(3):312.e23-31. doi: 10.1016/j.amjmed.2014.10.034. Epub 2014 Nov 13.
Despite growing evidence of complications, inferior vena cava filters are being used increasingly in patients with venous thromboembolism based on limited efficacy data. In such a controversial situation, the effectiveness of filter use on mortality as an adjuvant to antithrombotic therapy for pulmonary embolism remains uncertain.
Using the Diagnosis Procedure Combination database in Japan, we identified patients hospitalized with pulmonary embolism who received anticoagulation or thrombolytic therapy from the day of admission. We compared the in-hospital mortality between patients who received a filter and patients who did not, using propensity score and instrumental variable methods.
Of 13,125 eligible patients, 3948 received a filter, and 9177 did not receive a filter. The propensity score-matched analysis showed that filter use was significantly associated with lower in-hospital mortality than nonuse (2.6% vs 4.7%, P < .001; risk ratio 0.55; 95% confidence interval [CI], 0.43-0.71; risk difference -2.1%; 95% CI, -3.0% to -1.2%; number needed to treat, 48; 95% CI, 34-82). We obtained similar results in the inverse probability of treatment-weighting analysis. The instrumental variable analysis confirmed that filter use was associated with a decreased risk of in-hospital mortality with adjustment for all measured variables (risk difference -2.5%, 95% CI, -4.6% to -0.4%).
This study suggested that filter use was potentially effective for reducing in-hospital mortality in patients with pulmonary embolism. Prospective studies are needed to confirm the effectiveness observed in our results and to define which subpopulations of patients would benefit most from filters.
尽管有越来越多的并发症证据，但下腔静脉滤器仍基于有限的疗效数据在静脉血栓栓塞患者中越来越多地使用。在这种有争议的情况下，过滤器作为肺栓塞抗血栓治疗的辅助手段对死亡率的有效性仍不确定。
我们使用日本的诊断程序组合数据库，确定了从入院当天开始接受抗凝或溶栓治疗的肺栓塞住院患者。我们使用倾向评分和工具变量方法比较了接受过滤器和未接受过滤器的患者的住院死亡率。
在 13125 名合格患者中，有 3948 名接受了过滤器，9177 名未接受过滤器。倾向评分匹配分析表明，与未使用相比，使用过滤器与较低的住院死亡率显著相关（2.6%比 4.7%，P<.001；风险比 0.55；95%置信区间[CI]，0.43-0.71；风险差异-2.1%；95%CI，-3.0%至-1.2%；需要治疗的人数，48；95%CI，34-82）。我们在逆概率处理加权分析中获得了类似的结果。工具变量分析证实，在调整所有测量变量后，使用过滤器与降低住院死亡率相关（风险差异-2.5%，95%CI，-4.6%至-0.4%）。
这项研究表明，过滤器的使用可能有助于降低肺栓塞患者的住院死亡率。需要进行前瞻性研究来证实我们的研究结果所观察到的有效性，并确定哪些亚组患者最受益于过滤器。
