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

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.