Risks and benefits of prophylactic inferior vena cava filters in patients undergoing bariatric surgery.
Risks and benefits of prophylactic inferior vena cava filters in patients undergoing bariatric surgery.
复制标题
接受减肥手术的患者预防性下腔静脉滤器的风险和益处。
DOI：
10.1002/jhm.2013
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发表时间：
2013
影响因子：
2.6
通讯作者：
MichiganBariatricSurgeryCollaborative
中科院分区：
文献类型：
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作者：
Birkmeyer,NancyJ;Finks,JonathanF;English,WayneJ;Carlin,ArthurM;Hawasli,AbdelkaderA;Genaw,JeffreyA;Wood,MichaelH;Share,DavidA;Birkmeyer,JohnD;MichiganBariatricSurgeryCollaborative
背景：美国食品和药物管理局最近发布了关于接受下腔静脉（IVC）过滤器患者不良事件的警告。目的在控制基线患者特征和医学静脉血栓栓塞预防差异的情况下，评估下腔静脉滤器插入与并发症之间的关系。设计倾向匹配队列研究。密歇根减肥外科合作的前瞻性全州范围临床登记。患者：2006年至2012年间，来自32家医院的减肥手术患者（n=35,477）。干预：预防性下腔静脉滤器插入。测量结果包括在减肥手术后30天内并发症（肺栓塞、深静脉血栓形成和严重程度的并发症总合并率）的发生情况。结果1077例IVC滤过器患者与1077例匹配对照患者的基线特征无显著差异。病人接受印度河流域文明过滤器有较高的肺栓塞(0.84% vs 0.46%;优势比[或],2.0;95%可信区间(CI), 0.6还是6.5;P = 0.232),深静脉血栓形成(1.2% vs 0.37%;或者,3.3;95%置信区间,1.1还是10.1;P = 0.039),静脉血栓栓塞(1.9% vs 0.74%;或者,2.7;95%置信区间,1.1还是6.3,P = 0.027),严重的并发症(5.8% vs 3.8%;或者,1.6;95%置信区间,1.0还是2.4;P = 0.031),永久禁用并发症(1.2% vs 0.37%;或者,4.3;95%置信区间,1.2还是15.6;P = 0.028),和死亡(0.7% vs 0.09%;或者,7.0;95% ci, 0.9‐57.3;p =0.068)。在使用下腔静脉滤过器的7例死亡患者中，4例死于肺栓塞，2例死于下腔静脉血栓形成/闭塞。结论：我们没有发现在减肥手术患者中使用预防性下腔静脉滤过器的益处和显著的风险，并认为应不鼓励使用。医院医学杂志，2013;8:173-177。©2013医院医学学会
BACKGROUNDThe United States Food and Drug Administration recently issued a warning about adverse events in patients receiving inferior vena cava (IVC) filters.OBJECTIVETo assess relationships between IVC filter insertion and complications while controlling for differences in baseline patient characteristics and medical venous thromboembolism prophylaxis.DESIGNPropensity‐matched cohort study.SETTINGThe prospective, statewide, clinical registry of the Michigan Bariatric Surgery Collaborative.PATIENTSBariatric surgery patients (n=35,477) from 32 hospitals during the years 2006 through 2012.INTERVENTIONProphylactic IVC filter insertion.MEASUREMENTSOutcomes included the occurrence of complications (pulmonary embolism, deep vein thrombosis, and overall combined rates of complications by severity) within 30 days of bariatric surgery.RESULTSThere were no significant differences in baseline characteristics among the 1,077 patients with IVC filters and in 1,077 matched control patients. Patients receiving IVC filters had higher rates of pulmonary embolism (0.84% vs 0.46%; odds ratio [OR], 2.0; 95% confidence interval [CI], 0.6‐6.5;P=0.232), deep vein thrombosis (1.2% vs 0.37%; OR, 3.3; 95% CI, 1.1‐10.1;P=0.039), venous thromboembolism (1.9% vs 0.74%; OR, 2.7; 95% CI, 1.1‐6.3,P=0.027), serious complications (5.8% vs 3.8%; OR, 1.6; 95% CI, 1.0‐2.4;P=0.031), permanently disabling complications (1.2% vs 0.37%; OR, 4.3; 95% CI, 1.2‐15.6;P=0.028), and death (0.7% vs 0.09%; OR, 7.0; 95% CI, 0.9‐57.3;P=0.068). Of the 7 deaths among patients with IVC filters, 4 were attributable to pulmonary embolism and 2 to IVC thrombosis/occlusion.CONCLUSIONSWe have identified no benefits and significant risks to the use of prophylactic IVC filters among bariatric surgery patients and believe that their use should be discouraged.Journal of Hospital Medicine2013;8:173–177. © 2013 Society of Hospital Medicine