Vena cava filters in unstable elderly patients with acute pulmonary embolism

Am J Med. 2014 Mar;127(3):222-5. doi: 10.1016/j.amjmed.2013.11.003. Epub 2013 Nov 23.

Abstract

Background: Inferior vena cava filters are associated with a reduced in-hospital all-cause case fatality rate of unstable patients with acute pulmonary embolism. Whether vena cava filters are associated with a reduced case fatality rate in adults of all ages with unstable pulmonary embolism, particularly the elderly, has not been determined.

Methods: Unstable patients with pulmonary embolism (in shock or ventilator dependent) 1999-2008 were identified from the Nationwide Inpatient Sample.

Results: Among 21,095 unstable patients with pulmonary embolism who received thrombolytic therapy, in-hospital all-cause case fatality rate was lower in every age group who received a vena cava filter in addition to thrombolytic therapy (P = .0012 to <.0001). Patients aged ≥ 81 years showed the greatest absolute reduction of case fatality rate with filters (19.3%). Among 50,210 unstable patients who did not receive thrombolytic therapy, case fatality rate also was lower in every age group who received a vena cava filter (all P <.0001). Patients aged ≥ 81 years with vena cava filters showed the greatest absolute risk reduction of case fatality rate (27.7%).

Conclusion: Vena cava filters are associated with a reduced in-hospital all-cause case fatality rate in unstable adults with pulmonary embolism, irrespective of age.

Keywords: Pulmonary embolism; Vena cava filters; Venous thromboembolism.

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Aged, 80 and over
  • Critical Illness*
  • Female
  • Hospital Mortality
  • Humans
  • Male
  • Middle Aged
  • Pulmonary Embolism / drug therapy
  • Pulmonary Embolism / etiology
  • Pulmonary Embolism / mortality*
  • Pulmonary Embolism / prevention & control*
  • Risk Assessment
  • Sampling Studies
  • Thrombolytic Therapy*
  • United States / epidemiology
  • Vena Cava Filters*
  • Venous Thromboembolism / complications
  • Venous Thromboembolism / therapy*