Association of IVCF use with mortality and intracranial hemorrhage in patients with selected cancers and brain metastasis

Blood Vessels, Thrombosis & Hemostasis Pub Date : 2024-06-01 DOI:10.1016/j.bvth.2024.100011

Renata Abrahão , Ann Brunson , Vaibhav Kumar , Anjlee Mahajan , Nigel S. Key , Theresa Keegan , Ted Wun

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Abstract

We investigated the association of inferior vena cava filter (IVCF) usage with early mortality and intracranial hemorrhage (ICH) in patients with cancer and venous thromboembolism (VTE) with and without brain metastasis. We used the California Cancer Registry data linked to hospitalization and emergency department databases to identify patients (all ages) with melanoma, kidney, breast, or lung cancers who had acute VTE between 2005 and 2017 at hospital admission. The primary outcomes were 30-day mortality and 180-day ICH post-index VTE hospitalization. Of the 16 847 patients with cancer and VTE, 19.1% had brain metastasis. Patients with brain metastasis were more likely to receive an IVCF (odds ratio, 2.24; 95% confidence interval [CI], 2.01-2.50). Among patients with active bleeding, IVCF placement was associated with ∼50% reduction in 30-day mortality (hazard ratio [HR], 0.53; 95% CI, 0.42-0.68), regardless of the presence or absence of brain metastasis. In patients without active bleeding, 30-day mortality decreased by nearly 30% among those with brain metastasis who received IVCF (HR, 0.72; 95% CI, 0.60-0.85), with no difference among those without brain metastasis who had an IVCF inserted. Patients with brain metastasis had an elevated hazard of 180-day mortality (HR, 5.14; 95% CI, 2.99-8.83), but no association was found between IVCF insertion and 180-day ICH. Our study suggests a potential mortality benefit of IVCF use among patients with selected cancers and VTE, particularly among patients with active bleeding and those with brain metastasis with no bleeding. IVCF use was not associated with 180-day ICH. Randomized clinical trials are warranted to confirm our results.

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下腔静脉滤器与部分癌症和脑转移患者的死亡率和颅内出血的关系

摘要我们研究了下腔静脉滤器（IVCF）的使用与有或没有脑转移的癌症和静脉血栓栓塞症（VTE）患者的早期死亡率和颅内出血（ICH）的关系。我们利用与住院和急诊科数据库相连接的加州癌症登记数据，确定了 2005 年至 2017 年期间入院时患有急性 VTE 的黑色素瘤、肾癌、乳腺癌或肺癌患者（所有年龄段）。主要结果是指数 VTE 住院后 30 天死亡率和 180 天 ICH。在16 847名癌症和VTE患者中，19.1%有脑转移。脑转移患者更有可能接受 IVCF（几率比为 2.24；95% 置信区间 [CI]，2.01-2.50）。在活动性出血患者中，无论是否存在脑转移，IVCF置入与30天死亡率降低50%相关（危险比[HR]，0.53；95% 置信区间[CI]，0.42-0.68）。在没有活动性出血的患者中，接受了IVCF的脑转移患者的30天死亡率降低了近30%（HR，0.72；95% CI，0.60-0.85），而没有脑转移但植入了IVCF的患者的30天死亡率则没有差异。脑转移患者的180天死亡风险升高（HR，5.14；95% CI，2.99-8.83），但未发现插入IVCF与180天ICH之间存在关联。我们的研究表明，在特定癌症和 VTE 患者中使用 IVCF 可能会降低死亡率，尤其是在活动性出血患者和无出血的脑转移患者中。使用 IVCF 与 180 天 ICH 无关。需要进行随机临床试验来证实我们的结果。

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Blood Vessels, Thrombosis & Hemostasis

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