Bikdeli Behnood, Chatterjee Saurav, Desai Nihar R, Kirtane Ajay J, Desai Mayur M, Bracken Michael B, Spencer Frederick A, Monreal Manuel, Goldhaber Samuel Z, Krumholz Harlan M
Division of Cardiology, Department of Medicine, Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.
Temple University Hospital, Philadelphia, Pennsylvania.
J Am Coll Cardiol. 2017 Sep 26;70(13):1587-1597. doi: 10.1016/j.jacc.2017.07.775.
Inferior vena cava (IVC) filters are widely used for prevention of pulmonary embolism (PE). However, uncertainty persists about their efficacy and safety.
The authors conducted a systematic review and meta-analysis of the published reports on the efficacy and safety of IVC filters.
The authors searched PubMed, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov through October 3, 2016, for randomized controlled trials (RCTs) or prospective controlled observational studies of IVC filters versus none in patients at risk of PE. Inverse variance fixed-effects models with odds ratio (OR) as the effect measure were used for primary analyses. Main outcomes included subsequent PE, PE-related mortality, all-cause mortality, and subsequent deep vein thrombosis (DVT).
The authors' search retrieved 1,986 studies, of which 11 met criteria for inclusion (6 RCTs and 5 prospective observational studies). Quality of evidence for RCTs was low to moderate. Overall, patients receiving IVC filters had lower risk for subsequent PE (OR: 0.50; 95% confidence interval [CI]: 0.33 to 0.75); increased risk for DVT (OR: 1.70; 95% CI: 1.17 to 2.48); nonsignificantly lower PE-related mortality (OR: 0.51; 95% CI: 0.25 to 1.05); and no change in all-cause mortality (OR: 0.91; 95% CI: 0.70 to 1.19). Limiting the results to RCTs showed similar results. Findings were substantively similar across a wide range of sensitivity analyses.
Very few prospective controlled studies, with limited quality of evidence, exist regarding the efficacy and safety of IVC filters. Overall, filters appear to reduce the risk of subsequent PE, increase the risk for DVT, and have no significant effect on overall mortality.
下腔静脉（IVC）滤器被广泛用于预防肺栓塞（PE）。然而，其疗效和安全性仍存在不确定性。
作者对已发表的关于IVC滤器疗效和安全性的报告进行了系统评价和荟萃分析。
作者检索了截至2016年10月3日的PubMed、Cochrane对照试验中心注册库和ClinicalTrials.gov，以查找关于IVC滤器与未使用滤器相比在PE风险患者中的随机对照试验（RCT）或前瞻性对照观察性研究。以比值比（OR）作为效应量的逆方差固定效应模型用于主要分析。主要结局包括随后发生的PE、PE相关死亡率、全因死亡率和随后发生的深静脉血栓形成（DVT）。
作者的检索共获得1986项研究，其中11项符合纳入标准（6项RCT和5项前瞻性观察性研究）。RCT的证据质量为低到中等。总体而言，接受IVC滤器的患者随后发生PE的风险较低（OR：0.50；95%置信区间[CI]：0.33至0.75）；DVT风险增加（OR：1.70；95%CI：1.17至2.48）；PE相关死亡率略低但无统计学意义（OR：0.51；95%CI：0.25至1.05）；全因死亡率无变化（OR：0.91；95%CI：0.70至1.19）。将结果限于RCT显示了类似的结果。在广泛的敏感性分析中，结果基本相似。
关于IVC滤器疗效和安全性的前瞻性对照研究很少，证据质量有限。总体而言，滤器似乎降低了随后发生PE的风险，增加了DVT的风险，并且对总体死亡率没有显著影响。
