Usefulness of Inferior Vena Cava Filters in Unstable Patients With Acute Pulmonary Embolism and Patients Who Underwent Pulmonary Embolectomy

Abstract

Administrative data were analyzed from the Premier Healthcare Database, 2010 to 2014, to assess whether inferior vena cava (IVC) filters reduce mortality in unstable patients (in shock or on ventilator support) with acute pulmonary embolism and in stable patients who undergo surgical pulmonary embolectomy. Mortality was assumed to be due to pulmonary embolism in patients who had none of the co-morbid conditions listed in the Charlson Comorbidity Index. Data were determined on the basis of International Classification of Disease-9th Clinical Modification (ICD-9-CM) codes. All-cause mortality in unstable patients was lower with IVC filters in-hospital, 288 of 1,972 (23%) versus 1339 of 3002 (45%) (p <0.0001), and at 3 months, all-cause mortality was 316 of 1,272 (25%) versus 1,428 of 3,002 (48%) (p <0.0001). Pulmonary embolism mortality was lower with IVC filters in unstable patients in-hospital, 191 of 926 (21%) versus 913 of 2,138 (43%) (p <0.0001) and at 3 months, 215 of 926 (23%) versus 971 of 2,138 (45%) (p <0.0001). A lower in-hospital and 3-month all-cause mortality and pulmonary embolism mortality was also shown with IVC filters in stable patients who underwent pulmonary embolectomy. These data, in concert with previous retrospective data, suggest that unstable patients with pulmonary embolism and stable patients who undergo pulmonary embolectomy may benefit from an IVC filter. Further investigations would be useful.