OC 54.5 - Association of Inferior Vena Cava Filter (IVCF) Use and 30-Day Mortality and 180-Day Intracranial Hemorrhage among Patients with Brain Metastasis and Venous Thromboembolism: an Updated Analysis

Tuesday, June 27, 2023

11:45 – 12:00 ET

Room: 511

Session Available As: On-Demand

Co-Author(s)

RA

Renata Abrahao

Epidemiologist, Project Scientist
University of California Davis Comprehensive Cancer Center, Division of Hematology and Oncology
Berkeley, California, United States
AB

Ann Brunson

Senior Statistician
University of California Davis Comprehensive Cancer Center, Division of Hematology and Oncology
Sacramento, California, United States
VK

Vaibhav Kumar

Hematology and Oncology Fellow
University of North Carolina Lineberger Comprehensive Cancer Center
Chapel Hill, North Carolina, United States
AM

Anjlee Mahajan

Assistant Professor
University of California Davis Comprehensive Cancer Center, Division of Hematology and Oncology
Sacramento, California, United States
NK

Nigel S. Key

Harold R. Roberts Distinguished Professor
Division of Hematology, University of North Carolina, Chapel Hill, NC, USA
Chapel Hill, North Carolina, United States
TK

Theresa Keegan

Professor of Medicine
University of California Davis Comprehensive Cancer Center, Division of Hematology and Oncology
Sacramento, California, United States

Presenting Author(s)

Ted Wun, MD (he/him/his)

Associate Dean for Research, and Clinical and Translational Science Center Director
University of California Davis Comprehensive Cancer Center, Division of Hematology and Oncology
Sacramento, California, United States

Background: IVCF placement is not recommended in most patients with VTE.

Aims: We determined whether IVCF use among patients with venous thromboembolism (VTE) in selected cancers and brain metastasis decreases the risk of mortality and intracranial hemorrhage (ICH).

Methods: We used the California Cancer Registry and Hospitalization Databases to identify patients with breast or lung cancer (high prevalence of brain metastasis) and melanoma or renal cancer (high risk of ICH), with or without brain metastasis, who had an acute VTE (2005–2017). Propensity score multivariable Cox models were used for analyses. Primary outcomes were 30-day mortality and 180-day ICH from the discharge date of VTE.

Results: Of 16,500 patients, 19.6% had brain metastasis and, among these, 22.9% received an IVCF compared with 12.9% patients without brain metastasis. Patients with brain metastasis were more likely to receive IVCFs [odds ratio=1.83, 95% Confidence Interval (CI) 1.63–2.05]. Placement of IVCF was associated with borderline reduced risk of 30-day mortality among patients with brain metastasis [Hazard Ratio (HR)=0.85, CI 0.73–1.00], but no mortality benefit was observed among those without brain metastasis [HR=1.10, CI 0.97–1.25]. When stratified by active bleeding, IVCF placement was associated with reduced risk of 30-day mortality (HR=0.73, CI 0.58–0.93), but there was no difference in mortality between patients with or without brain metastasis. Among patients without active bleeding, IVCF placement was not associated with reduced mortality (HR=1.07, CI 0.96–1.20). The presence of brain metastasis was associated with increased risk of 180-day ICH (HR=7.13, CI 5.00–10.16). IVCF placement was not associated with decreased risk of ICH (HR=1.48, CI 0.95–2.32).

Conclusion(s): These results suggest that IVCF decreased 30-day mortality among patients with VTE and brain metastasis and among those with active bleeding, regardless of the presence of brain metastasis. Randomized clinical trials are needed to confirm these results.

Learning Objectives:

Describe the use of inferior vena cava filters (IVCF) in California patients with colon cancer, breast cancer, melanoma, and renal cell carcinoma who have venous thromboembolism and brain metastases.
Identify subgroups of patients that may have reduced 30-day mortaility associated with the use of IVCF amongst these patients.
Summarize the strengths and limitations of large observational studies using linked registry and administrative datasets.