Porceddu Enrica, Talerico Rosa, Ciasca Gabriele, Cammà Giulia, Di Santo Riccardo, Peri Matilde, Cina Alessandro, Pola Roberto, Porfidia Angelo
Thrombosis Unit, Department of Geriatric, Orthopedic, and Rheumatologic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
Department of Neuroscience, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Roma, Italy.
J Clin Med. 2024 Apr 15;13(8):2285. doi: 10.3390/jcm13082285.
It is reasonable to place an Inferior Vena Cava Filter (IVCF) when an acute deep vein thrombosis (DVT) of the lower limbs occurs in a patient with absolute contraindication to therapeutic anticoagulation. An additional potential reason for placing an IVCF is the need to stop therapeutic anticoagulation in a patient with acute DVT who must undergo urgent non-deferrable surgery. However, IVCFs are often used outside of such established indications and many authors argue about their actual utility, especially in terms of survival. In this retrospective study, we looked for clinical correlates of in-hospital mortality among patients who underwent IVCF placement, limiting our analysis to the cases for which a correct indication to IVCF placement existed. : We retrospectively analyzed the electronic database of our University Hospital, searching for consecutive hospitalized patients who had acute DVT and underwent IVCF placement because of an established contraindication to therapeutic anticoagulation and/or because it was necessary to stop anticoagulation due to urgent surgery. The search covered the period between 1 January 2010 and 31 December 2020. The search resulted in the identification of 168 individuals. An established contraindication to therapeutic anticoagulation was present in 116 patients (69.0%), while urgent non-deferrable surgery was the reason for IVCF placement in 52 patients (31.0%). A total of 24 patients (14.3%) died during the same hospital stay in which the IVCF was placed. Mortality rate was significantly higher in patients with a contraindication to anticoagulation than in patients who underwent IVCF placement because of urgent surgery (19.0% vs. 3.8%, OD 5.85 vs. 0.17). In-hospital mortality was also significantly higher among patients with chronic kidney disease and those who needed blood cell transfusion during hospitalization. This study provides novel information on clinical correlates of in-hospital mortality among patients with acute DVT who undergo IVCF. Prospective observational studies are needed to substantiate these findings.
对于存在治疗性抗凝绝对禁忌证的下肢急性深静脉血栓形成（DVT）患者，植入下腔静脉滤器（IVCF）是合理的。植入IVCF的另一个潜在原因是，对于患有急性DVT且必须接受紧急非延期手术的患者，需要停止治疗性抗凝。然而，IVCF常常在这些既定适应证之外使用，许多作者对其实际效用存在争议，尤其是在生存方面。在这项回顾性研究中，我们寻找了接受IVCF植入患者的院内死亡临床相关因素，将分析局限于存在IVCF植入正确适应证的病例。：我们回顾性分析了我校医院的电子数据库，搜索因既定的治疗性抗凝禁忌证和/或因紧急手术需要停止抗凝而患有急性DVT并接受IVCF植入的连续住院患者。搜索涵盖2010年1月1日至2020年12月31日期间。搜索结果确定了168例患者。116例患者（69.0%）存在治疗性抗凝的既定禁忌证，而52例患者（31.0%）因紧急非延期手术是植入IVCF的原因。共有24例患者（14.3%）在植入IVCF的同一住院期间死亡。抗凝禁忌证患者的死亡率显著高于因紧急手术接受IVCF植入的患者（19.0%对3.8%，比值比5.85对0.17）。慢性肾脏病患者和住院期间需要输血的患者的院内死亡率也显著更高。 本研究提供了关于接受IVCF植入的急性DVT患者院内死亡临床相关因素的新信息。需要前瞻性观察性研究来证实这些发现。
