Effect of inferior vena cava filters on pulmonary embolism-related mortality and major complications: a systematic review and meta-analysis of randomized controlled trials

Abstract

Objective: 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.

Methods: 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.

Results: 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 (I² = 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).

Conclusions: 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.

Keywords: Deep venous thromboembolism; Inferior vena cava filter; Mortality; Pulmonary embolism.