Clinical outcomes of retrievable inferior vena cava filter plus anticoagulation versus anticoagulation alone on high-risk patients: A meta-analysis

BACKGROUND:

Inferior vena cava filters (IVC) have been used in addition to oral anticoagulation (OC) in patients at high-risk for development of new pulmonary embolism (PE). There is few data comparing the risk-benefit from adding IVC. We sought to compare the clinical outcomes from using IVC combined to OC to OC alone.

METHODS:

We searched Pub Med and Cochrane trough October 2015 for RCTs that directly compared IVC + OC to OC only in patients at high-risk for new development or recurrence of PE. Primary outcome was development of new PE. Secondary outcomes included recurrence of DVT, major bleeding and death. We used Fixed or Random Effect analysis using the Cochrane Handbook of Systematic Reviews and RevMan 5.2 for statistical analysis.

RESULTS:

Out of 571 articles, four RCTs were included. The pooled data provided 1004 patients; 503 treated with IVC+ OC and 501 with OC. Mean follow up were 3 months. IVC + OC group presented with significant less new PE compared to OC only group (1.3% vs. 3.5%, p=0.03). There was no difference between IVC + OC compared to OC only for new DVT (7.7% vs. 7.7%), major bleeding (4.3% vs. 4.1%) and death (7.3% vs. 5.5%) respectively (Figure 1).

CONCLUSIONS:

Our study suggests that among patients at high-risk for venous thromboembolic events, IVC use is associated with significant less development of PE. It is yet to be determined if this benefit is sustained at long-term follow and associated with survival benefit. Therefore further randomized trials are warranted.