Abstract 14256: Examining the Efficacy of Inferior Vena Cava Filters in the Direct Oral Anticoagulant Era

Abstract

Introduction: No previous reports have adequately demonstrated whether inferior vena cava filters prevent pulmonary embolism, and reports of disadvantages, such as worsening venous thrombosis, have led to a decrease in the frequency of their use. However, in actual clinical practice, patients often encounter situations in which they expect to benefit from inferior vena cava filters; hence, exploratory studies examining their efficacy continue. Hypothesis & Methods: We analyzed data from the COMMAND VTE Registry-2, a multi center, retrospective, observational study of symptomatic venous thrombosis in the DOAC era, for cases using inferior vena cava filters. Results: A total of 5197 cases of venous thrombosis were enrolled, among whom 483 (9%) had inferior vena cava filters implanted. The inferior vena cava filter was implanted long-term and removed in 6% and 3% of cases, respectively. Inferior vena cava filters tended to be implanted in patients with active cancer patients, with more patients with terminal cancer, on anticancer therapy, and with distant metastases having long-term filter implantation (P = 0.001). After inferior vena cava filter implantation, the inferior vena cava filter implantation group showed a significantly lower incidence of pulmonary embolism within 30 days after the onset of initial venous thrombosis (P = 0.011). However, Kaplan-Meier analysis during a median follow-up of 854 days showed that long-term implantation of inferior vena cava filters significantly increased incidence of deep vein thrombosis (P = 0.001), whereas multivariate analysis found that long-term implantation of inferior vena cava filters was an independent risk factor for deep vein thrombosis (HR: 2.096, 95% CI: 1.254-3.508, P = 0.005). Conclusions: Inferior vena cava filters may be effective in preventing pulmonary emboli in the short term; however, even in the DOAC era, long-term filter implantations were associated with an increased incidence of deep vein thrombosis.