Skip to main content
Top
Published in: CardioVascular and Interventional Radiology 8/2019

01-08-2019 | Acute Pulmonary Embolism | Review

Inferior Vena Cava Filters in Hemodynamically Unstable Patients with Acute Pulmonary Embolism: How Often are They Used? Data from Multicenter Prospective Registries on Acute Pulmonary Embolism

Authors: Marco Zuin, Gianluca Rigatelli, Pietro Zonzin, Loris Roncon

Published in: CardioVascular and Interventional Radiology | Issue 8/2019

Login to get access

Abstract

The use of inferior vena cava (IVC) filters is recommended in patients with acute pulmonary embolism (PE) who have absolute contraindications to anticoagulant drugs and/or in those subjects with recurrent PE despite treated with an adequate anticoagulant regimen. During the last 2 decades, some investigations have demonstrated that the use of IVC filters in high-risk PE patients, treated or not with systemic thrombolysis, was able to reduce the short-term mortality rate if inserted early after the acute event. The aim of the present review is to analyze the use of IVC filters in high-risk PE patients enrolled in prospective multicenter registries between 1990 and 2018. After screening 3542 article in PubMed, Scopus, Cochrane library and Goggle Scholar databases, we identified four registry studies meeting the inclusion criteria. In a prospective cohort of 39,056 patients, 1387 (3.5%) were hemodynamically unstable at admission. Among them, IVC filters were used only in 2.7% of cases. Conversely, IVC filters were inserted in 3.8% of hemodynamically stable patients. Over the years, a fluctuating trend in the use of IVC filters was observed. In the absence of randomized controlled trial on this issue, which would be difficult, if not impossible to realize, data obtained from the medical literature seem to suggest that IVC filters could represent a valid adjunctive therapy in hemodynamically unstable PE patients, able to prevent further hemodynamic deterioration. Further and larger subgroup analyses, obtained both by prospective and retrospective studies, are necessary to clarify this therapeutic approach.
Literature
1.
go back to reference Goldhaber SZ, Bounameaux H. Pulmonary embolism and deep vein thrombosis. Lancet. 2012;379:1835–46.CrossRefPubMed Goldhaber SZ, Bounameaux H. Pulmonary embolism and deep vein thrombosis. Lancet. 2012;379:1835–46.CrossRefPubMed
2.
go back to reference Zuin M, Rigatelli G, Faggian G, Zonzin P, Roncon L. Short-term outcome of patients with history of significant coronary artery disease following acute pulmonary embolism. Eur J Intern Med. 2016;34:e16–7.CrossRefPubMed Zuin M, Rigatelli G, Faggian G, Zonzin P, Roncon L. Short-term outcome of patients with history of significant coronary artery disease following acute pulmonary embolism. Eur J Intern Med. 2016;34:e16–7.CrossRefPubMed
3.
go back to reference Konstantinides SV, Barco S. Prevention of early complications and late consequences after acute pulmonary embolism: focus on reperfusion techniques. Thromb Res. 2018;164:163–9.CrossRefPubMed Konstantinides SV, Barco S. Prevention of early complications and late consequences after acute pulmonary embolism: focus on reperfusion techniques. Thromb Res. 2018;164:163–9.CrossRefPubMed
4.
go back to reference Zuin M, Rigatelli G, Carraro M, Pastore G, Lanza D, Zonzin P, Zuliani G, Roncon L. Systemic thrombolysis in haemodynamically unstable pulmonary embolism: the earlier the better? Thromb Res. 2019;173:117–23.CrossRefPubMed Zuin M, Rigatelli G, Carraro M, Pastore G, Lanza D, Zonzin P, Zuliani G, Roncon L. Systemic thrombolysis in haemodynamically unstable pulmonary embolism: the earlier the better? Thromb Res. 2019;173:117–23.CrossRefPubMed
5.
go back to reference Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galiè N, Gibbs JS, Huisman MV, Humbert M, Kucher N, Lang I, Lankeit M, Lekakis J, Maack C, Mayer E, Meneveau N, Perrier A, Pruszczyk P, Rasmussen LH, Schindler TH, Svitil P, Vonk Noordegraaf A, Zamorano JL, Zompatori M, Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2014;2014(35):3033–69. Konstantinides SV, Torbicki A, Agnelli G, Danchin N, Fitzmaurice D, Galiè N, Gibbs JS, Huisman MV, Humbert M, Kucher N, Lang I, Lankeit M, Lekakis J, Maack C, Mayer E, Meneveau N, Perrier A, Pruszczyk P, Rasmussen LH, Schindler TH, Svitil P, Vonk Noordegraaf A, Zamorano JL, Zompatori M, Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J. 2014;2014(35):3033–69.
6.
go back to reference Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, Huisman M, King CS, Morris TA, Sood N, Stevens SM, Vintch JRE, Wells P, Woller SC, Moores L. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 2016;149:315–52.CrossRef Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, Huisman M, King CS, Morris TA, Sood N, Stevens SM, Vintch JRE, Wells P, Woller SC, Moores L. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 2016;149:315–52.CrossRef
7.
go back to reference Steinberger JD, Genshaft SJ. The role of inferior vena cava filters in pulmonary embolism. Tech Vasc Interv Radiol. 2017;20:197–205.CrossRefPubMed Steinberger JD, Genshaft SJ. The role of inferior vena cava filters in pulmonary embolism. Tech Vasc Interv Radiol. 2017;20:197–205.CrossRefPubMed
8.
go back to reference Stein PD, Dalen JE, Matta F, Hughes MJ. Optimal therapy for unstable pulmonary embolism. Am J Med. 2019;132:168–71.CrossRefPubMed Stein PD, Dalen JE, Matta F, Hughes MJ. Optimal therapy for unstable pulmonary embolism. Am J Med. 2019;132:168–71.CrossRefPubMed
9.
go back to reference Stein PD, Matta F, Lawrence FR, Hughes MJ. Importance of early insertion of inferior vena cava filters in unstable patients with acute pulmonary embolism. Am J Med. 2018;131:1104–9.CrossRefPubMed Stein PD, Matta F, Lawrence FR, Hughes MJ. Importance of early insertion of inferior vena cava filters in unstable patients with acute pulmonary embolism. Am J Med. 2018;131:1104–9.CrossRefPubMed
10.
go back to reference Stein PD, Matta F, Lawrence FR, Hughes MJ. Usefulness of inferior vena cava filters in unstable patients with acute pulmonary embolism and patients who underwent pulmonary embolectomy. Am J Cardiol. 2018;121:495–500.CrossRefPubMed Stein PD, Matta F, Lawrence FR, Hughes MJ. Usefulness of inferior vena cava filters in unstable patients with acute pulmonary embolism and patients who underwent pulmonary embolectomy. Am J Cardiol. 2018;121:495–500.CrossRefPubMed
11.
go back to reference Dalen JE, Stein PD. Is there a subgroup of PE patients who benefit from inferior vena cava filters? J Am Coll Cardiol. 2016;67:1036–7.CrossRefPubMed Dalen JE, Stein PD. Is there a subgroup of PE patients who benefit from inferior vena cava filters? J Am Coll Cardiol. 2016;67:1036–7.CrossRefPubMed
12.
go back to reference Casazza F, Becattini C, Bongarzoni A, Cuccia C, Roncon L, Favretto G, Zonzin P, Pignataro L, Agnelli G. Clinical features and short term outcomes of patients with acute pulmonary embolism. The Italian Pulmonary Embolism Registry (IPER). Thromb Res. 2012;130:847–52.CrossRefPubMed Casazza F, Becattini C, Bongarzoni A, Cuccia C, Roncon L, Favretto G, Zonzin P, Pignataro L, Agnelli G. Clinical features and short term outcomes of patients with acute pulmonary embolism. The Italian Pulmonary Embolism Registry (IPER). Thromb Res. 2012;130:847–52.CrossRefPubMed
13.
go back to reference Agnelli G, Verso M, Ageno W, Imberti D, Moia M, Palareti G, Rossi R, Pistelli R, MASTER investigators. The MASTER registry on venous thromboembolism: description of the study cohort. Thromb Res. 2008;121:605–10.CrossRefPubMed Agnelli G, Verso M, Ageno W, Imberti D, Moia M, Palareti G, Rossi R, Pistelli R, MASTER investigators. The MASTER registry on venous thromboembolism: description of the study cohort. Thromb Res. 2008;121:605–10.CrossRefPubMed
14.
go back to reference Budaj-Fidecka A, Kurzyna M, Fijałkowska A, Żyłkowska J, Wieteska M, Florczyk M, Szewczyk G, Torbicki A, Filipiak KJ, Opolski G, ZATPOL Registry Investigators. In-hospital major bleeding predicts mortality in patients with pulmonary embolism: an analysis of ZATPOL Registry data. Int J Cardiol. 2013;168:3543–9.CrossRefPubMed Budaj-Fidecka A, Kurzyna M, Fijałkowska A, Żyłkowska J, Wieteska M, Florczyk M, Szewczyk G, Torbicki A, Filipiak KJ, Opolski G, ZATPOL Registry Investigators. In-hospital major bleeding predicts mortality in patients with pulmonary embolism: an analysis of ZATPOL Registry data. Int J Cardiol. 2013;168:3543–9.CrossRefPubMed
15.
go back to reference Ageno W, Haas S, Weitz JI, Goldhaber SZ, Turpie AGG, Goto S, Angchaisuksiri P, Nielsen JD, Kayani G, Pieper KS, Schellong S, Bounameaux H, Mantovani LG, Prandoni P, Kakkar AK, GARFIELD-VTE investigators. Characteristics and management of patients with venous thromboembolism: the GARFIELD-VTE Registry. Thromb Haemost. 2019;119:319–27.CrossRefPubMed Ageno W, Haas S, Weitz JI, Goldhaber SZ, Turpie AGG, Goto S, Angchaisuksiri P, Nielsen JD, Kayani G, Pieper KS, Schellong S, Bounameaux H, Mantovani LG, Prandoni P, Kakkar AK, GARFIELD-VTE investigators. Characteristics and management of patients with venous thromboembolism: the GARFIELD-VTE Registry. Thromb Haemost. 2019;119:319–27.CrossRefPubMed
16.
go back to reference Cohen AT, Gitt AK, Bauersachs R, Fronk EM, Laeis P, Mismetti P, Monreal M, Willich SN, Bramlage P, Agnelli G, Prefer In Vte Scientific Steering Committee And The Prefer In Vte Investigators OBOT. The management of acute venous thromboembolism in clinical practice. Results from the European PREFER in VTE Registry. Thromb Haemost. 2017;117:1326–37.CrossRefPubMedPubMedCentral Cohen AT, Gitt AK, Bauersachs R, Fronk EM, Laeis P, Mismetti P, Monreal M, Willich SN, Bramlage P, Agnelli G, Prefer In Vte Scientific Steering Committee And The Prefer In Vte Investigators OBOT. The management of acute venous thromboembolism in clinical practice. Results from the European PREFER in VTE Registry. Thromb Haemost. 2017;117:1326–37.CrossRefPubMedPubMedCentral
17.
go back to reference Tanabe Y, Yamamoto T, Murata T, Mabuchi K, Hara N, Mizuno A, Nozato T, Hisatake S, Obayashi T, Takayama M, Nagao K. Gender differences among patients with acute pulmonary embolism. Am J Cardiol. 2018;122:1079–84.CrossRefPubMed Tanabe Y, Yamamoto T, Murata T, Mabuchi K, Hara N, Mizuno A, Nozato T, Hisatake S, Obayashi T, Takayama M, Nagao K. Gender differences among patients with acute pulmonary embolism. Am J Cardiol. 2018;122:1079–84.CrossRefPubMed
18.
go back to reference Spirk D, Husmann M, Hayoz D, Baldi T, Frauchiger B, Engelberger R, Amann-Vesti B, Baumgartner I, Kucher N. Predictors of in-hospital mortality in elderly patients with acute venous thrombo-embolism: the SWIss Venous ThromboEmbolism Registry (SWIVTER). Eur Heart J. 2012;33:921–6.CrossRefPubMed Spirk D, Husmann M, Hayoz D, Baldi T, Frauchiger B, Engelberger R, Amann-Vesti B, Baumgartner I, Kucher N. Predictors of in-hospital mortality in elderly patients with acute venous thrombo-embolism: the SWIss Venous ThromboEmbolism Registry (SWIVTER). Eur Heart J. 2012;33:921–6.CrossRefPubMed
19.
go back to reference Kucher N, Rossi E, De Rosa M, Goldhaber SZ. Massive pulmonary embolism. Circulation. 2006;113:577–82.CrossRefPubMed Kucher N, Rossi E, De Rosa M, Goldhaber SZ. Massive pulmonary embolism. Circulation. 2006;113:577–82.CrossRefPubMed
20.
go back to reference Lin BW, Schreiber DH, Liu G, Briese B, Hiestand B, Slattery D, Kline JA, Goldhaber SZ, Pollack CV Jr. Therapy and outcomes in massive pulmonary embolism from the Emergency Medicine Pulmonary Embolism in the Real World Registry. Am J Emerg Med. 2012;30:1774–81.CrossRefPubMed Lin BW, Schreiber DH, Liu G, Briese B, Hiestand B, Slattery D, Kline JA, Goldhaber SZ, Pollack CV Jr. Therapy and outcomes in massive pulmonary embolism from the Emergency Medicine Pulmonary Embolism in the Real World Registry. Am J Emerg Med. 2012;30:1774–81.CrossRefPubMed
21.
go back to reference Jimenez S, Ruiz-Artacho P, Merlo M, et al. Risk profile, management, and outcomes of patients with venous thromboembolism attended in Spanish Emergency Departments: the ESPHERIA Registry. Medicine (Baltimore). 2017;96:e8796.CrossRef Jimenez S, Ruiz-Artacho P, Merlo M, et al. Risk profile, management, and outcomes of patients with venous thromboembolism attended in Spanish Emergency Departments: the ESPHERIA Registry. Medicine (Baltimore). 2017;96:e8796.CrossRef
22.
go back to reference Jiménez D, Bikdeli B, Barrios D, Quezada A, Del Toro J, Vidal G, Mahé I, Quere I, Loring M, Yusen RD, Monreal M, RIETE investigators. Epidemiology, patterns of care and mortality for patients with hemodynamically unstable acute symptomatic pulmonary embolism. Int J Cardiol. 2018;269:327–33.CrossRefPubMed Jiménez D, Bikdeli B, Barrios D, Quezada A, Del Toro J, Vidal G, Mahé I, Quere I, Loring M, Yusen RD, Monreal M, RIETE investigators. Epidemiology, patterns of care and mortality for patients with hemodynamically unstable acute symptomatic pulmonary embolism. Int J Cardiol. 2018;269:327–33.CrossRefPubMed
23.
go back to reference Decousus H, Leizorovicz A, Parent F, Page Y, Tardy B, Girard P, Laporte S, Faivre R, Charbonnier B, Barral FG, Huet Y, Simonneau G. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. Prévention du Risque d’Embolie Pulmonaire par Interruption Cave Study Group. N Engl J Med. 1998;338:409–15.CrossRefPubMed Decousus H, Leizorovicz A, Parent F, Page Y, Tardy B, Girard P, Laporte S, Faivre R, Charbonnier B, Barral FG, Huet Y, Simonneau G. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. Prévention du Risque d’Embolie Pulmonaire par Interruption Cave Study Group. N Engl J Med. 1998;338:409–15.CrossRefPubMed
25.
go back to reference Kaufman JA, Kinney TB, Streiff MB, Sing RF, Proctor MC, Becker D, Cipolle M, Comerota AJ, Millward SF, Rogers FB, Sacks D, Venbrux AC. Guidelines for the use of retrievable and convertible vena cava filters: report from the Society of Interventional Radiology multidisciplinary consensus conference. J Vasc Interv Radiol. 2006;17:449–59.CrossRefPubMed Kaufman JA, Kinney TB, Streiff MB, Sing RF, Proctor MC, Becker D, Cipolle M, Comerota AJ, Millward SF, Rogers FB, Sacks D, Venbrux AC. Guidelines for the use of retrievable and convertible vena cava filters: report from the Society of Interventional Radiology multidisciplinary consensus conference. J Vasc Interv Radiol. 2006;17:449–59.CrossRefPubMed
26.
27.
go back to reference Wadhwa V, Gutta NB, Trivedi PS, Chatterjee K, Ahmed O, Ryu RK, Kalva SP. In-hospital mortality benefit of inferior vena cava filters in patients with pulmonary embolism and congestive heart failure. AJR Am J Roentgenol. 2018;211:672–6.CrossRefPubMed Wadhwa V, Gutta NB, Trivedi PS, Chatterjee K, Ahmed O, Ryu RK, Kalva SP. In-hospital mortality benefit of inferior vena cava filters in patients with pulmonary embolism and congestive heart failure. AJR Am J Roentgenol. 2018;211:672–6.CrossRefPubMed
28.
go back to reference Stein PD, Matta F, Keyes DC, Willyerd GL. Impact of vena cava filters on in-hospital case fatality rate from pulmonary embolism. Am J Med. 2012;125:478–84.CrossRefPubMed Stein PD, Matta F, Keyes DC, Willyerd GL. Impact of vena cava filters on in-hospital case fatality rate from pulmonary embolism. Am J Med. 2012;125:478–84.CrossRefPubMed
29.
go back to reference Stein PD, Matta F. Vena cava filters in unstable elderly patients with acute pulmonary embolism. Am J Med. 2014;127:222–5.CrossRefPubMed Stein PD, Matta F. Vena cava filters in unstable elderly patients with acute pulmonary embolism. Am J Med. 2014;127:222–5.CrossRefPubMed
30.
go back to reference Bikdeli B, Chatterjee S, Desai NR, Kirtane AJ, Desai MM, Bracken MB, Spencer FA, Monreal M, Goldhaber SZ, Krumholz HM. Inferior vena cava filters to prevent pulmonary embolism: systematic review and meta-analysis. J Am Coll Cardiol. 2017;70:1587–97.CrossRef Bikdeli B, Chatterjee S, Desai NR, Kirtane AJ, Desai MM, Bracken MB, Spencer FA, Monreal M, Goldhaber SZ, Krumholz HM. Inferior vena cava filters to prevent pulmonary embolism: systematic review and meta-analysis. J Am Coll Cardiol. 2017;70:1587–97.CrossRef
31.
go back to reference Zuin M, Kuo WT, Rigatelli G, Daggubati R, Vassiliev D, Roncon L. Catheter-directed therapy as a first-line treatment strategy in hemodynamically unstable patients with acute pulmonary embolism: yes or no? Int J Cardiol. 2016;225:14–5.CrossRefPubMed Zuin M, Kuo WT, Rigatelli G, Daggubati R, Vassiliev D, Roncon L. Catheter-directed therapy as a first-line treatment strategy in hemodynamically unstable patients with acute pulmonary embolism: yes or no? Int J Cardiol. 2016;225:14–5.CrossRefPubMed
32.
go back to reference Jaff MR, McMurtry MS, Archer SL, et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation. 2011;123:1788–830.CrossRefPubMed Jaff MR, McMurtry MS, Archer SL, et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation. 2011;123:1788–830.CrossRefPubMed
33.
go back to reference Minocha J, Smith AM, Kapoor BS, et al. ACR appropriateness criteria® radiologic management of venous thromboembolism-inferior vena cava filters. J Am Coll Radiol. 2019;16:S214–26.CrossRefPubMed Minocha J, Smith AM, Kapoor BS, et al. ACR appropriateness criteria® radiologic management of venous thromboembolism-inferior vena cava filters. J Am Coll Radiol. 2019;16:S214–26.CrossRefPubMed
Metadata
Title
Inferior Vena Cava Filters in Hemodynamically Unstable Patients with Acute Pulmonary Embolism: How Often are They Used? Data from Multicenter Prospective Registries on Acute Pulmonary Embolism
Authors
Marco Zuin
Gianluca Rigatelli
Pietro Zonzin
Loris Roncon
Publication date
01-08-2019
Publisher
Springer US
Published in
CardioVascular and Interventional Radiology / Issue 8/2019
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI
https://doi.org/10.1007/s00270-019-02242-5

Other articles of this Issue 8/2019

CardioVascular and Interventional Radiology 8/2019 Go to the issue