Inferior Vena Cava Filters in Elderly Patients with Stable Acute Pulmonary Embolism

Abstract

BackgroundPatients aged >60 years with pulmonary embolism who were stable and did not require thrombolytic therapy were shown to have a somewhat lower in-hospital all-cause mortality with vena cava filters. In this investigation we further assess mortality with filters in stable elderly patients. MethodsIn-hospital all-cause mortality according to use of inferior vena cava filters was assessed from the National (Nationwide) Inpatient Sample, 2003-2012, in: 1) All patients with pulmonary embolism; 2) All with pulmonary embolism who had none of the comorbid conditions listed in the Charlson Comorbidity Index; 3) Patients with a primary (first-listed) diagnosis of pulmonary embolism, and 4) Patients with a primary diagnosis of pulmonary embolism and none of the comorbid conditions listed in the Charlson Comorbidity Index. ResultsFrom 2003-2012, 2,621,575 stable patients with pulmonary embolism were hospitalized in the US. Patients aged >80 years showed lower mortality with vena cava filters (all pulmonary embolism, 6.1% vs 10.5%; all pulmonary embolism with no comorbid conditions, 3.3% vs 6.3%; primary pulmonary embolism, 4.1% vs 5.7%; primary pulmonary embolism with no comorbid conditions, 2.1% vs 3.7%; all P <.0001). In the all-patient category, patients aged 71-80 years showed somewhat lower mortality with filters, 6.3% vs 7.4% (P <.0001), and those without comorbid conditions, 2.5% vs 2.8% (P = .04). Those aged 71-80 years with primary pulmonary embolism, irrespective of comorbid conditions, did not show lower mortality with filters. ConclusionAt present, in the absence of a randomized controlled trial, it seems prudent to consider a vena cava filter in very elderly (aged >80 years) stable patients with acute pulmonary embolism.