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Volume 338:409-416 February 12, 1998 Number 7 Next

	Full Text PDF Editorial by Haire, W. D. Letters Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background The efficacy and safety of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis are still a matter of debate.

Methods Using a two-by-two factorial design, we randomly assigned 400 patients with proximal deep-vein thrombosis who were at risk for pulmonary embolism to receive a vena caval filter (200 patients) or no filter (200 patients), and to receive low-molecular-weight heparin (enoxaparin, 195 patients) or unfractionated heparin (205 patients). The rates of recurrent venous thromboembolism, death, and major bleeding were analyzed at day 12 and at two years.

Results At day 12, two patients assigned to receive filters (1.1 percent), as compared with nine patients assigned to receive no filters (4.8 percent), had had symptomatic or asymptomatic pulmonary embolism (odds ratio, 0.22; 95 percent confidence interval, 0.05 to 0.90). At two years, 37 patients assigned to the filter group (20.8 percent), as compared with 21 patients assigned to the no-filter group (11.6 percent), had had recurrent deep-vein thrombosis (odds ratio, 1.87; 95 percent confidence interval, 1.10 to 3.20). There were no significant differences in mortality or the other outcomes. At day 12, three patients assigned to low-molecular-weight heparin (1.6 percent), as compared with eight patients assigned to unfractionated heparin (4.2 percent), had had symptomatic or asymptomatic pulmonary embolism (odds ratio, 0.38; 95 percent confidence interval, 0.10 to 1.38).

Conclusions In high-risk patients with proximal deep-vein thrombosis, the initial beneficial effect of vena caval filters for the prevention of pulmonary embolism was counterbalanced by an excess of recurrent deep-vein thrombosis, without any difference in mortality. Our data also confirmed that low-molecular-weight heparin was as effective and safe as unfractionated heparin for the prevention of pulmonary embolism.

Source Information

From the Thrombosis Research Group, Clinical Pharmacology Unit (H.D., S.L.), Intensive Care Unit (Y.P., B.T.), and Department of Radiology (F.-G.B.), Bellevue Hospital, Saint-Etienne; the Clinical Pharmacology Unit, Cardiological Hospital, Lyons (A.L.); the Respiratory Unit, Antoine Béclère Hospital, Clamart (F.P., G.S.); the Institut Mutualiste Montsouris, Paris (P.G.); the Cardiology Unit, Clinique Saint-Vincent, Besançon (R.F.); the Cardiology Unit, Trousseau Hospital, Tours (B.C.); and Rhône–Poulenc Rorer, Paris (Y.H.) — all in France.

Address reprint requests to Dr. Decousus at the Thrombosis Research Group, Clinical Pharmacology Unit, Hôpital Bellevue, CHU Saint-Etienne, 42055 Saint-Etienne CEDEX 2, France.

Full Text of this Article

Related Letters:

Vena Caval Filters for the Prevention of Pulmonary Embolism
Chuu W.-M., Wang N.-Y., Perry D., Murphy T. P., Trerotola S. O., Vogelzang R. L., Greenfield L. J., Proctor M. C., Decousus H., Mismetti P., Tardy B., The Prevention du Risque d'Embolie Pulmonaire par Interruption Cave Study Group
Extract | Full Text  
N Engl J Med 1998; 339:46-48, Jul 2, 1998. Correspondence

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Schrijvers D., Van den Brande J., Vermorken J. B., Corbanese U., Possamai C., Blatt P. M., Marlar R. A., Joist J. H., Fink L. M., Goldhaber S. Z.
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N Engl J Med 1998; 339:1555-1557, Nov 19, 1998. Correspondence

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