REASSESSMENT OF VENA-CAVAL FILTER USE IN PATIENTS WITH CANCER

PURPOSE: Noting a doubling in mortality soon after placement of filters in the inferior vena cava (IVC) from 1985 (7.8%) to 1992 (15.2%), the authors performed a study to define risk factors associated with death soon after IVC filter placement and to develop revised guidelines for filter placement. PATIENTS AND METHODS: During a 4-year period, 141 IVC filters were placed in 137 patients. Patients were divided into two clinical risk groups: those with possible malignancy and those with possible suprainguinal venous thrombus. Survival was monitored for up to 3 weeks after hospital discharge. RESULTS: Death occurred in 16 (26%) of 61 patients with malignancy (P = .0086, compared with patients without malignancy), seven (35%) of 20 patients with suprainguinal venous thrombus (P = .0422, compared with patients without suprainguinal venous thrombus), and six (46.2%) of 13 patients with malignancy and suprainguinal venous thrombus (P = .0091, compared with patients without malignancy or suprainguinal venous thrombus). CONCLUSION: The data indicate that for some patients with malignancy or suprainguinal venous thrombus, insertion of an IVC filter gives little or no survival benefit. A reassessment of IVC filter use in these patients is warranted.