Inferior Vena Cava Filter Placed in Neurologic Intensive Care Unit: Effectiveness,Retrieval Rate,and Mortality

Abstract

Purpose:

Patients in neurologic intensive care unit (NICU) often undergo inferior vena cava filter (IVCF) placement for venous thrombotic events. This study aims to determine the effectiveness of IVCF, filter retrieval, and mortality among patients that received IVCF in NICU.

Materials and Methods:

In this single institutional, noncomparative, retrospective study, all patients who were admitted to NICU and underwent IVCF placement from April 2015 to December 2020 were reviewed. IVCF was successfully deployed in all 175 patients [100%; median age 68 years, female 84/175 (48.0%)]. The 3 most common causes for NICU admission were intracranial hemorrhage (66/175, 37.7%), ischemic stroke (62/175, 35.4%), and traumatic brain injury (16/175, 9.1%). Deep vein thrombosis and pulmonary embolism (PE) were confirmed in 155 (88.6%) and 35 (20.0%) patients at the time of filter placement, respectively. Primary outcomes of interest were postfilter placement PE, filter retrieval, and inhospital mortality. Baseline characteristics were analyzed using t-tests and chi-squared test for continuous and noncontinuous variables, respectively. Factors associated with primary outcomes were analyzed with a logistic regression model.

Results:

Post-IVCF PE occurred in 3 patients (1.7%) with a median follow-up of 3 months. Excluding 26 inhospital deaths (14.9%, none was related to PE), filters were retrieved in 31 discharged patients (20.8%) with a median filter dwelling time of 9 months. Advanced filter retrieval required a higher fluoroscopy time (median 3.3 minutes vs 8.3 minutes, p = 0.016) and contrast volume use (median 35.0 ml vs 57.5 ml, p = 0.0028) than standard technique. No procedure-related complication occurred during filter placement and retrieval. Sequential Organ Failure Assessment (SOFA, p = 0.012) and Simplified Acute Physiology Scores (SAPS, p = 0.016) were independently associated with inhospital mortality. Modified Rankin Score (mRS) at discharge was an independent predictor for filter retrieval (p < 0.001).

Conclusion:

Despite safety and effectiveness, IVCF retrieval rate for NICU patients was low, particularly those with worse mRS at time of hospital discharge. Worse SOFA and SAPS scores were associated with inhospital mortality.

Clinical Impact

Inferior vena cava filter (IVCF) is effective preventing post-filter pulmonary embolism (PE) in neurologic intensive care unit (NICU) patients, with only 1.7% experiencing PE post-placement, underscoring its role in managing venous thrombotic events in this high-risk population; however, the low retrieval rate of IVCFs, particularly in patients with poorer functional outcomes (worse mRS at discharge), and the association of higher SOFA and SAPS scores with increased inhospital mortality, emphasize the need for improved strategies to optimize filter retrieval and patient selection in critically ill neurologic patients.

Keywords

inferior vena cava filter intracranial hemorrhage intensive care stroke venous thromboembolism

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