Du Plessis Lodewyk E, Mol Ben W, Svigos John M
Women's and Babies Division, Women's and Children's Hospital, North Adelaide, SA, Australia.
Discipline of Obstetrics and Gynaecology, University of Adelaide, SA, Australia; The Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, SA, Australia.
Obstet Med. 2016 Sep;9(3):102-5. doi: 10.1177/1753495X16648026. Epub 2016 May 12.
Pregnant women with venous thromboembolism are traditionally managed with anticoagulation, but inferior vena cava filters are an alternative. We balanced risks and benefits of an inferior vena cava filter in a decision analysis.
We constructed a decision model to compare in pregnant women with VTE the outcome of (1) inferior vena cava filter and anticoagulant treatment versus (2) anticoagulant treatment only.
Assuming a 63% risk reduction from an inferior vena cava filter (baseline mortality rate of venous thromboembolism of 0.5%), 318 women would need to be treated with inferior vena cava filters to prevent one venous thromboembolism related maternal death. Sensitivity analyses indicated that at a mortality rate of 0.5% the risk reduction from inferior vena cava filters needed to be 80%, while at a mortality rate of 2% a risk reduction of 20% would justify inferior vena cava filters.
In view of their potential morbidity, inferior vena cava filters should be restricted to pregnant woman at strongly increased risk of recurrent venous thromboembolism.
传统上，患有静脉血栓栓塞症的孕妇采用抗凝治疗，但下腔静脉滤器是一种替代方法。我们在一项决策分析中权衡了下腔静脉滤器的风险和益处。
我们构建了一个决策模型，以比较患有静脉血栓栓塞症的孕妇中（1）下腔静脉滤器与抗凝治疗联合使用与（2）仅采用抗凝治疗的结果。
假设下腔静脉滤器可使风险降低63%（静脉血栓栓塞症的基线死亡率为0.5%），则需要对318名妇女使用下腔静脉滤器进行治疗，以预防1例与静脉血栓栓塞症相关的孕产妇死亡。敏感性分析表明，在死亡率为0.5%时，下腔静脉滤器需要将风险降低80%，而在死亡率为2%时，风险降低20%就可证明下腔静脉滤器的合理性。
鉴于下腔静脉滤器潜在的发病率，应将其限制在复发性静脉血栓栓塞症风险大幅增加的孕妇中使用。
