Falatko John M, Dalal Bhavinkumar, Qu Lihua
Critical Care/Pulmonary Medicine, Beaumont Health System, Detroit, MI, USA; Outcomes Research, Beaumont Research Institute, Detroit, MI, USA.
Critical Care/Pulmonary Medicine, Beaumont Health System, Detroit, MI, USA.
Heart Lung Circ. 2017 Dec;26(12):1317-1322. doi: 10.1016/j.hlc.2017.01.011. Epub 2017 Feb 28.
Anticoagulation is the primary treatment for pulmonary embolism (PE). Inferior vena cava (IVC) filters are an adjunctive intervention to prevent recurrent pulmonary embolism. Long-term outcomes in elderly patients with contraindications to anticoagulation after IVC filter placement for prevention of recurrent pulmonary embolism have yet to be assessed.
Patients ≥60years of age, that had an IVC filter placed between 1 January, 2008 and 2 February, 2013, with a primary diagnosis of pulmonary embolism, were included. Patients that died during index hospitalisation, were discharged to hospice, or had active malignancy were excluded. The primary endpoint was overall survival. Patients were divided depending on whether they were treated with an approved anticoagulant for VTE or had no anticoagulant.
Of the 152 patients identified, 55 were not anti-coagulated after IVC filter placement. The incidence of death was 0.4 per 1000 filter days and 0.7 per 1000 filter days in the anti-coagulated and untreated groups respectively (p-value=0.06). After statistical correction for co-morbid conditions, the effect of anticoagulation was not significant (HR 0.82 CI 0.49-1.37, p-value 0.46). Age was a significant confounder that was associated with death. Increased BMI was protective. Indications for IVC filter placement were numerous, but similar between the two groups.
Treatment with an approved anticoagulant is recommended after IVC filter placement for prevention of recurrent PE, however its effect may be attenuated by advanced age. In elderly patients that have undergone IVC filter placement for prevention of recurrent PE, survival may be more dependent on age and co-morbid conditions than exposure to anticoagulation.
抗凝是肺栓塞（PE）的主要治疗方法。下腔静脉（IVC）滤器是预防复发性肺栓塞的辅助干预措施。对于因抗凝禁忌而植入IVC滤器以预防复发性肺栓塞的老年患者，其长期预后尚未得到评估。
纳入2008年1月1日至2013年2月2日期间植入IVC滤器、主要诊断为肺栓塞的60岁及以上患者。排除在索引住院期间死亡、出院至临终关怀机构或患有活动性恶性肿瘤的患者。主要终点是总生存期。根据患者是否接受批准的VTE抗凝治疗或未接受抗凝治疗进行分组。
在确定的152例患者中，55例在植入IVC滤器后未接受抗凝治疗。抗凝组和未治疗组的死亡发生率分别为每1000滤器日0.4例和每1000滤器日0.7例（p值 = 0.06）。在对合并症进行统计校正后，抗凝的效果不显著（HR 0.82，CI 0.49 - 1.37，p值0.46）。年龄是与死亡相关的显著混杂因素。BMI增加具有保护作用。植入IVC滤器的指征众多，但两组之间相似。
为预防复发性PE植入IVC滤器后，建议使用批准的抗凝剂进行治疗，然而其效果可能会因高龄而减弱。在因预防复发性PE而植入IVC滤器的老年患者中，生存可能更多地取决于年龄和合并症，而非抗凝治疗。
