A prospective long-term study of 220 patients with a retrievable vena cava filter for secondary prevention of venous thromboembolism
A prospective long-term study of 220 patients with a retrievable vena cava filter for secondary prevention of venous thromboembolism
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DOI：
10.1378/chest.06-0631
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发表时间：
2007-01-01
期刊：
影响因子：
9.6
通讯作者：
Barral, Fabrice Guy
中科院分区：
文献类型：
--
作者：
Mismetti, Patrick;Rivron-Guillot, Karine;Barral, Fabrice Guy
背景资料：直接和长期的临床事件与可回收的过滤器（ALN过滤器; ALN植入物Chiralcicaux; Ghisonaccia，法国）的放置和取出仍然在很大程度上unknow.Methods：这是一项前瞻性队列研究，随访18个月。结果：1999年4月至2005年6月期间，在我院放射科有220例患者需要置入ALN滤器（平均年龄，70.8岁），随访中位持续时间为338.5天（范围，1至561天）; 148例患者（67.3%）完成了18个月的随访。无患者无法接受随访。所有患者都有急性或既往静脉血栓栓塞。主要适应症为尽管进行了充分抗凝治疗但仍复发性静脉血栓栓塞（10.9%）、一过性出血事件（21.8%）、明确的抗凝治疗禁忌症（26.8%）或因大手术、重大创伤或侵入性操作而必须停止抗凝治疗（37.7%）。98.6%的患者成功插入滤器，11.8%的患者发生即刻并发症。滤器植入的中位持续时间为166天（第一至第三四分位数，34至478天）。同时，17.0%（217例患者中的37例）至少发生1起静脉血栓栓塞事件。在中位数为51天（范围，6至352天）后，25.3%的患者尝试回收滤器; 92.7%的患者首次尝试成功取出滤器。结论：滤器可以很容易地插入并在插入后一年内成功取出。其预防肺栓塞的安全性和有效性应在随机研究中进行适当评估。
Background: The immediate and long-term clinical events associated with the placement and removal of a retrievable filter (ALN filter; ALN Implants Chirurgicaux; Ghisonaccia, France) remain largely unknown.Methods: This was a prospective cohort study with an 18-month follow-up. All consecutive patients scheduled for placement of an ALN filter between April 1999 and June 2005 in the Radiology Department of our hospital were included.Results: During the study period, placement of an ALN filter was indicated in 220 patients (mean age, 70.8 years), who were followed up for a median duration of 338.5 days (range, 1 to 561 days); 148 patients (67.3%) completed the 18-month follow-up. No patients were unavailable for follow-up. All patients had an acute or past venous thromboembolism. Main indications were recurrent venous thromboembolism despite adequate anticoagulation therapy (10.9%), transient bleeding event (21.8 %), definitive contraindication for anticoagulant therapy (26.8 %), or obligation to stop anticoagulant therapy due to major surgery, major trauma, or invasive procedure (37.7%). Filter insertion was successful in 98.6% of patients and resulted in an immediate complication in 11.8%. The median duration of filter implantation was 166 days (first to third quartiles, 34 to 478 days). Meanwhile, 17.0% (37 of 217 patients) had at least one venous thromboembolic event. Filter retrieval was attempted in 25.3% of patients after a median of 51 days (range, 6 to 352 days); removal was successful at the first attempt in 92.7% of patients.Conclusions: The filter could be easily inserted and successfully removed up to I year after insertion. Its safety and efficacy in preventing pulmonary embolism should be properly assessed in a randomized study.