Raghavendran Prashant, Lim Ming Y
Division of General Internal Medicine, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, United States.
Division of Hematology/Oncology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, United States.
TH Open. 2019 Apr 29;3(2):e117-e122. doi: 10.1055/s-0039-1688569. eCollection 2019 Apr.
Systemic anticoagulation is regarded as optimal treatment and prophylaxis of venous thromboembolism (VTE). In malignancy, bleeding risk is increased while the patients remain hypercoagulable, making anticoagulation management troublesome. Inferior vena cava (IVC) filters have emerged as an option in the management of VTE, especially when anticoagulant agents are contraindicated. There is limited data on the overall outcomes of patients with malignancy and IVC filter placement. This descriptive study identifies individuals with filters placed and reviews outcomes to guide appropriate care of patients with malignancy and VTE. We performed a retrospective chart review of 115 patients with malignancy who had a filter placed between July 2014 and December 2016. Eighty-seven patients were tracked until December 2017 for significant events (VTE and/or death). In total, 61% ( = 70) had metastatic solid tumor malignancy and 77% ( = 88) were receiving anticoagulation therapy prior to IVC filter placement. Fifty-three percent ( = 61) had bleeding events and 25% ( = 29) had thrombocytopenia. Patients with isolated solid tumors receiving frequent surgery were also common recipients of filters. Sixty-six percent (57/87) of patients had a significant event; 85% of them were anticoagulated. Eighty-two percent of events occurred within 6 months of filter placement, with death occurring on average within 5 months of placement. Overall, use of IVC filters was more common in cancer patients who developed bleeding complications on anticoagulation and with metastatic malignancy. However, in patients with metastatic or hematologic disease, filter placement did not prevent all-cause mortality. Individualized risk-benefit consideration is needed before IVC filters are placed.
全身抗凝被视为静脉血栓栓塞症（VTE）的最佳治疗和预防方法。在恶性肿瘤患者中，出血风险增加，而患者仍处于高凝状态，这使得抗凝管理变得棘手。下腔静脉（IVC）滤器已成为VTE管理的一种选择，尤其是在抗凝剂禁忌的情况下。关于恶性肿瘤患者放置IVC滤器的总体结果的数据有限。这项描述性研究确定了放置滤器的个体，并回顾了结果，以指导对恶性肿瘤和VTE患者的适当护理。我们对2014年7月至2016年12月期间放置滤器的115例恶性肿瘤患者进行了回顾性病历审查。87例患者被追踪至2017年12月，以了解重大事件（VTE和/或死亡）。总体而言，61%（n = 70）患有转移性实体肿瘤恶性肿瘤，77%（n = 88）在放置IVC滤器之前接受抗凝治疗。53%（n = 61）发生出血事件，25%（n = 29）患有血小板减少症。接受频繁手术的孤立实体肿瘤患者也是滤器的常见接受者。66%（57/87）的患者发生了重大事件；其中85%接受了抗凝治疗。82%的事件发生在滤器放置后的6个月内，死亡平均发生在放置后的5个月内。总体而言，IVC滤器在因抗凝出现出血并发症的癌症患者和转移性恶性肿瘤患者中使用更为普遍。然而，在转移性或血液系统疾病患者中，放置滤器并不能预防全因死亡率。在放置IVC滤器之前，需要进行个体化的风险效益考量。
