Department of Radiotherapy, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, People's Republic of China.
Emergency Intensive Care Ward, First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China.
J Vasc Surg Venous Lymphat Disord. 2021 May;9(3):792-800.e2. doi: 10.1016/j.jvsv.2021.02.008. Epub 2021 Feb 19.
Inferior vena cava (IVC) filters are often used. However, no clear consensus has been reached regarding the benefits and risks from randomized, controlled trials. Therefore, we investigated benefits and risks of IVC filter use.
The PubMed and Cochrane Library databases were searched from inception to October 31, 2019 to identify randomized, controlled trials for inclusion in our meta-analysis. The primary outcome was mortality related to pulmonary embolism (PE). The secondary outcomes were overall mortality, PE, deep vein thrombosis, and major bleeding. Risk ratios were pooled using the Mantel-Haenszel method with the fixed effects model for low heterogeneity. Otherwise, the random effects model was used. Risk differences were considered candidates of effect size if some of the data could not be pooled in the calculations.
Seven articles with 1274 patients were included. We found no significant difference in mortality related to PE between the IVC filter and control groups within 3 months (risk difference, -0.01; 95% confidence interval, -0.03 to 0.00; P = .11) nor during the entire follow-up period with low heterogeneity (I = 0%). The new occurrence of PE within 3 months and during the whole follow-up period was lower in the IVC filter group than in the control group (0.81% vs 5.98%; risk ratio, 0.17; 95% CI, 0.04-0.65; P = .01; and 3.2% vs 7.79%; risk ratio, 0.42; 95% CI, 0.25-0.71; P = .001, respectively). No significant differences were found in the rates of the new occurrence of deep vein thrombosis, major bleeding, and mortality during the whole follow-up period between the two groups (P > .05).
We found insufficient evidence to conclude that the use of IVC filters can reduce mortality. However, the use of IVC filters decreased the new occurrence of PE without increasing deep vein thrombosis or major bleeding.
下腔静脉（IVC）滤器通常被使用。然而，随机对照试验并未达成关于其获益和风险的明确共识。因此，我们调查了 IVC 滤器使用的获益和风险。
从建立数据库至 2019 年 10 月 31 日，我们在 PubMed 和 Cochrane 图书馆数据库中进行检索，以纳入我们的荟萃分析的随机对照试验。主要结局是与肺栓塞（PE）相关的死亡率。次要结局是总死亡率、PE、深静脉血栓形成和大出血。使用固定效应模型的 Mantel-Haenszel 方法汇总风险比，用于低异质性的情况。否则，使用随机效应模型。如果某些数据无法在计算中进行汇总，则认为风险差异是效应量的候选者。
纳入了 7 项包含 1274 名患者的研究。我们发现，在 3 个月内（风险差异，-0.01；95%置信区间，-0.03 至 0.00；P=.11）以及整个随访期间（低异质性 I 2= 0%），IVC 滤器组与对照组之间的 PE 相关死亡率无显著差异。在 3 个月内和整个随访期间，IVC 滤器组新发生的 PE 低于对照组（0.81% vs 5.98%；风险比，0.17；95%置信区间，0.04-0.65；P=.01；以及 3.2% vs 7.79%；风险比，0.42；95%置信区间，0.25-0.71；P=.001）。两组在整个随访期间的新发生深静脉血栓形成、大出血和死亡率方面无显著差异（P＞.05）。
我们发现证据不足，无法得出使用 IVC 滤器可降低死亡率的结论。然而，使用 IVC 滤器可降低新发 PE 的发生，而不增加深静脉血栓形成或大出血的风险。
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