Background:
Venous thromboembolism (VTE) is a common cause of morbidity in the hospital setting. Active malignancy and the use of cytotoxic therapy contribute to this risk. Inferior vena cava (IVC) filters may be placed despite a lack of prospective evidence to support their use. They may be placed in settings where there is a contraindication to or a need to interrupt anticoagulation, or when there is recurrent VTE despite anticoagulation. We sought to audit use of IVC filters in our hospital and patient outcomes.
Methods:
We conducted a retrospective audit of IVC filter use at our hospital over a three year period (2014 – 2016). Charts were reviewed and data on the indication for filter insertion and medical comorbidities were collected.
Outcomes:
45 patients received IVC filters. 27 were female, median age 64 years (21 – 92 years). Filters were inserted due to contraindication to anticoagulation (n=28); failure of anticoagulation to prevent further VTE (n=10); and seven due to high risk features. 44 attempts at insertion were successful (98%). Only 13 patients had attempts to retrieve their filter, with 10 of these successful. Compliance to guidelines for filter insertion was variable.
Most patients (32) had malignancy, 23 of whom had metastatic disease. Most had gynaecological (12) or gastrointestinal (11) malignancy. All 10 patients receiving filters for recurrent VTE had malignancy. Seventeen patients died (all of malignancy) during follow up. Fifteen of these patients had their IVC filter in situ at death, one patient had their filter removed, and one patient had an unsuccessful attempt at filter insertion. No patients died due to complications of their filter. The median time from insertion to death was 122 days (range 10 – 526 days).
Conclusion:
Insertion of filters in our institution is frequent, and often performed in the setting of active malignancy.