Vena cava filter insertion as a primary therapy for deep venous thrombosis in patients with malignant disease

ABSTRACT

Anticoagulation therapy in patients with malignant disease and deep venous thrombosis [DVT] carries a high hemorrhagic complication rate. Pulmonary showers may also not be properly controlled on anticoagulation. Accordingly, a policy of placing Greenfield vena cava filters [GFs] was established, as a primary therapy instead of anticoagulation whenever this was possible. Since 1988 till present, 40 patients with malignant disease [blood or visceral] and DVT, were treated. 15 patients had GFs as a primary therapy and 25 patients underwent anticoagulation therapy at their own request after explaining both modalities of treatment. The purpose of this study was to compare the result of anticoagulation versus GFs insertion in these two groups of patients. The anticoagulation group A showed a significantly higher number of major complications than GFs group B. Massive pulmonary embolism [PE] occurred in 2 patients despite adequate anticoagulation both resulted in death of the patients. 4 major bleeding episodes occurred, 3 of those were gastrointestinal and one intracerebral. The patients with intracerebral bleeding developed a major stroke and subsequently died. The 3 patients with gastrointestinal bleeding required transfusion of more than 4 units of blood and all received platelet transfusions and one of them subsequently died. Although this study is a small nonrandomized one, the data indicate that GF placement is safer than anticoagulation in patients with malignant disease and DVT