Abstract
Cancer patients with acute venous thromboembolism (VTE) have complex management needs, and the use of inferior vena cava (IVC) filters remains controversial. Despite guideline recommendations limiting IVC filter use to select situations, their utilization and associated outcomes in the contemporary era are unclear. We sought to evaluate trends in IVC filter use, baseline characteristics, and in-hospital outcomes among hospitalized cancer patients with acute deep venous thrombosis (DVT) in the United States from 2018 to 2022, using the National Inpatient Sample (NIS).
METHODS We conducted a retrospective, cross-sectional analysis of adults (2018–2022) using the NIS. We compared clinical characteristics, comorbidities, hospital characteristics, and outcomes including mortality, bleeding, and resource use between patients with hematologic malignancies versus solid tumors. Survey-weighted analyses were performed to generate national estimates. Continuous variables were compared using t-tests and categorical variables using chi-square tests, with significance defined as P < 0.05.
RESULTS Among 1,952,499 DVT patients, 300,480 (15.4%) had cancer, of whom 43,470 received IVC filters. Of these, 5,755 (13.2%) had hematologic malignancies and 37,715 (86.8%) had solid tumors. The proportion of IVC filter use among cancer-associated DVT showed no significant annual trend from 2018–2022 (range: 18–22%) (P=0.62).
Patients with hematologic malignancies were older (70.7 vs 67.1 years, p<0.0001) and more likely to be male (59% vs 48%, p<0.0001). Hematologic malignancy patients had higher rates of thrombocytopenia (25% vs 16%, p<0.0001) and neutropenia (7% vs 3%, p<0.0001) but lower rates of pulmonary embolism (19% vs 25%, p=0.0002). Patients with hematologic malignancies had significantly longer length of stay (14.6 vs 12.2 days, p<0.0001) and higher total charges ($250,687 vs $183,588, p<0.0001). They were more likely to require mechanical ventilation (15% vs 9%, p<0.0001) and vasopressor support (6% vs 4%, p=0.002). Nonetheless, in-hospital mortality was numerically higher in hematologic patients but not statistically significant (11% vs 9%, p=0.136).
CONCLUSION Cancer patients with DVT who receive IVC filters represent a high-risk population with substantial healthcare resource utilization. In this nationally representative sample, IVC filter use in cancer patients with acute DVT remains common, stable over time, and associated with higher resource utilization despite similar rates of in-hospital mortality. These findings raise important questions about the risk-benefit profile of IVC filters in this vulnerable population and support the need for prospective studies and risk-stratified approaches to guide practice of thrombosis management in cancer patients.
