This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (68)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Venous Thromboembolism  • Alert me on articles by topic

Richard H. White, MD, FACP; Hong Zhou, PhD; Jinwoo Kim, MD; Patrick S. Romano, MD, MPH

Arch Intern Med. 2000;160:2033-2041.

Background  There are few population-based data regarding the effectiveness of inferior vena cava filter use in the prevention of symptomatic pulmonary embolism.

Objective  To determine the 1-year cumulative incidence of rehospitalization for venous thrombosis or pulmonary embolism among patients with thromboembolism treated with a vena cava filter compared with the incidence in a control population with thromboembolism.

Patients and Methods  Population-based retrospective analysis of linked hospital discharge abstracts in California. From January 1, 1991, through December 30, 1995, 3632 patients were treated with a filter and 64,333 controls were admitted with a principal diagnosis of venous thromboembolism.

Results  Filter-treated patients had significantly greater comorbidity, with a higher frequency of previous pulmonary embolism, recent major bleeding, malignant neoplasm, and stroke. Patients who initially manifested pulmonary embolism were significantly more likely to be rehospitalized for pulmonary embolism than patients with an initial diagnosis of venous thrombosis alone, among filter-treated patients (relative risk, 6.72; 95% confidence interval, 3.61-12.49) and controls (relative risk, 5.30; 95% confidence interval, 4.61-6.10). Risk-adjusted proportional hazards modeling showed no significant difference between filter-treated patients and controls in the relative hazard of rehospitalization for pulmonary embolism. However, filter placement was associated with a significantly higher relative hazard of rehospitalization for venous thrombosis among patients who initially manifested pulmonary embolism (relative hazard, 2.62; 95% confidence interval, 2.09-3.29), but not among those who presented with venous thrombosis (relative hazard, 1.14; 95% confidence interval, 0.92-1.43).

Conclusions  Insertion of a vena cava filter was not associated with a significant reduction in the 1-year incidence of rehospitalization for pulmonary embolism. Use of a filter was associated with a higher incidence of rehospitalization for venous thrombosis, but only among patients who initially manifested pulmonary embolism. A prospective clinical study is needed to determine the efficacy of filter use among patients with pulmonary embolism who do not meet strict guidelines for insertion of a vena cava filter.

From the Division of General Medicine, Department of Medicine (Drs White, Zhou, and Romano), the Department of Statistics (Dr Zhou), and the Department of Medicine (Dr Kim), University of California–Davis.

RELATED ARTICLE

Archives of Internal Medicine Reader's Choice: Continuing Medical Education
Arch Intern Med. 2000;160(13):2068-2069.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Excellent outcome after surgical treatment of massive pulmonary embolism in critically ill patients.
Kadner et al.
J. Thorac. Cardiovasc. Surg. 2008;136:448-451.
ABSTRACT | FULL TEXT  

Antithrombotic Therapy for Venous Thromboembolic Disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)
Kearon et al.
Chest 2008;133:454S-545S.
ABSTRACT | FULL TEXT  

Anticoagulation in the Treatment of Venous Thromboembolism in Patients with Cancer
Falanga et al.
Am Soc Clin Oncol Ed Book 2008;2008:258-268.
ABSTRACT | FULL TEXT  

Pulmonary Embolism in the Critically Ill
Carlbom and Davidson
Chest 2007;132:313-324.
ABSTRACT | FULL TEXT  

Management of Venous Thromboembolism: A Clinical Practice Guideline from the American College of Physicians and the American Academy of Family Physicians
Snow et al.
ANN INTERN MED 2007;146:204-210.
ABSTRACT | FULL TEXT  

Management of Venous Thromboembolism: A Systematic Review for a Practice Guideline
Segal et al.
ANN INTERN MED 2007;146:211-222.
ABSTRACT | FULL TEXT  

Management of Venous Thromboembolism: A Clinical Practice Guideline from the American College of Physicians and the American Academy of Family Physicians
Snow et al.
Ann Fam Med 2007;5:74-80.
ABSTRACT | FULL TEXT  

A Prospective Long-term Study of 220 Patients With a Retrievable Vena Cava Filter for Secondary Prevention of Venous Thromboembolism
Mismetti et al.
Chest 2007;131:223-229.
ABSTRACT | FULL TEXT  

Economic burden of deep-vein thrombosis, pulmonary embolism, and post-thrombotic syndrome.
MacDougall et al.
Am J Health Syst Pharm 2006;63:S5-S15.
ABSTRACT | FULL TEXT  

Cost-Effectiveness of Low-Molecular-Weight Heparin for Treatment of Pulmonary Embolism
Aujesky et al.
Chest 2005;128:1601-1610.
ABSTRACT | FULL TEXT  

Eight-Year Follow-Up of Patients With Permanent Vena Cava Filters in the Prevention of Pulmonary Embolism: The PREPIC (Prevention du Risque d'Embolie Pulmonaire par Interruption Cave) Randomized Study
The PREPIC Study Group
Circulation 2005;112:416-422.
ABSTRACT | FULL TEXT  

Long-Term Management of Patients After Venous Thromboembolism
Kearon
Circulation 2004;110:I-10-I-18.
ABSTRACT | FULL TEXT  

Twenty-one-Year Trends in the Use of Inferior Vena Cava Filters
Stein et al.
Arch Intern Med 2004;164:1541-1545.
ABSTRACT | FULL TEXT  

Deep Venous Thrombosis
Lopez et al.
ASH Education Book 2004;2004:439-456.
ABSTRACT | FULL TEXT  

Acute Pulmonary Embolism: Part II: Risk Stratification, Treatment, and Prevention
Goldhaber and Elliott
Circulation 2003;108:2834-2838.
FULL TEXT  

The Epidemiology of Venous Thromboembolism
White
Circulation 2003;107:I-4-8.
ABSTRACT | FULL TEXT  

Natural History of Venous Thromboembolism
Kearon
Circulation 2003;107:I-22-30.
ABSTRACT | FULL TEXT  

British Thoracic Society guidelines for the management of suspected acute pulmonary embolism
Thorax 2003;58:470-483.
FULL TEXT  

Vena Caval Filters: A Review for Intensive Care Specialists
Streiff
J Intensive Care Med 2003;18:59-79.
ABSTRACT  

Medical Literature and Vena Cava Filters* : So Far So Weak
Girard et al.
Chest 2002;122:963-967.
ABSTRACT | FULL TEXT  

How we diagnose and treat deep vein thrombosis
Hirsh and Lee
Blood 2002;99:3102-3110.
ABSTRACT | FULL TEXT  

Modern treatment of pulmonary embolism
Goldhaber
Eur Respir J 2002;19:22S-27s.
ABSTRACT | FULL TEXT