Association of Inferior Vena Cava Filter with Mortality and Intracranial Hemorrhage in Patients with Selected Cancers and Brain Metastasis

IntroductionWe 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.MethodsWe used California Cancer Registry data linked to hospitalization and emergency department databases to identify patients (all ages) with melanoma, kidney, breast or lung cancer who had an acute VTE during 2005–2017 at hospital admission. Primary outcomes were 30-day mortality and 180-day ICH post-index VTE hospitalization.ResultsOf 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 approximately 50% reduction in 30-day mortality (Hazard Ratio (HR)=0.53, 95% CI 0.42–0.68), regardless the presence/absence of brain metastasis. In patients without active bleeding, 30-day mortality was decreased by nearly 30% among those with brain metastasis who received an IVCF (HR=0.72, 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, 2.99–8.83), but no association was found between IVCF insertion and 180-day ICH.ConclusionsOur 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. IVFC use was not associated with 180-day ICH. Randomized clinical trials are warranted to confirm our results.