Treat PE with Anticoagulation Alone

May 14, 2015

Treat PE with Anticoagulation Alone

  1. Neil H. Winawer, MD, SFHM

A French study shows no benefit of adding inferior vena cava filters to anticoagulation in patients with severe acute pulmonary embolism.

  1. Neil H. Winawer, MD, SFHM

One strategy for managing severe acute venous thromboembolism is placing inferior vena cava (IVC) filters as add-on therapy in patients who are candidates for anticoagulation. Because of the paucity of data on long-term risks and benefits of this approach, guidelines vary.

In this study, nearly 400 patients hospitalized in France with acute symptomatic pulmonary embolism (PE) associated with lower-limb venous thrombosis and ≥1 additional criterion for disease severity were randomized to anticoagulation with retrievable IVC filter implantation or anticoagulation alone. Disease-severity criteria were older age (age, >75), active cancer, chronic cardiac or respiratory disease, recent ischemic stroke with leg paralysis, and right ventricular dysfunction or myocardial injury. Patients in both groups received full-dose, guideline-adherent anticoagulation for ≥6 months

At 3 months and 6 months, no differences were observed between groups for recurrent PE, recurrent deep venous thrombosis, major bleeding, or death from any cause.

Comment

These findings do not support use of retrievable IVC filters in patients with severe acute PE who can be treated with anticoagulation alone. Such patients include those with submassive PE, defined as systolic blood pressure >90 mm Hg with either right ventricular dysfunction or myocardial necrosis; two thirds of patients in both treatment groups met these criteria. Whether IVC filters add any benefit to anticoagulation in hemodynamically unstable PE patients is unknown.

Editor Disclosures at Time of Publication

  • Disclosures for Neil H. Winawer, MD, SFHM at time of publication Equity Synthetic Biologics Editorial boards ACP Hospitalist (Board Member)

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