Abstract Number: PB2361
Meeting: ISTH 2020 Congress
Theme: Venous Thromboembolism and Cardioembolism » VTE Prophylaxis
Background: Prophylactic placement of inferior vena cava (IVC) filters has become a common intervention prior to performing bariatric surgery due to concerns about the high risk of venous thromboembolism (VTE) in this population and the unclear efficacy of standard dose pharmacologic prophylaxis in this high body weight population.
Aims: The objective of this systematic review and meta-analysis was to better characterize the risk and benefit of IVC filter insertion prior to bariatric surgery and to clarify the appropriate context for their use.
Methods: A systematic review of the literature of patients with prophylactic IVC filter insertion prior to bariatric surgery was performed using EMBASE, MEDLINE, CENTRAL (Cochrane) up to and including March 2018. The protocol was published in PROSPERO (CRD42018103411). Studies were independently assessed for inclusion and extracted for data by the authors. Quality was assessed using the Newcastle-Ottawa Scale with meta-analysis conducted on data from studies with Newcastle-Ottawa score >5.
Results: 26 studies were identified for inclusion into the review, of which none were randomized controlled trials. Meta-analysis was performed for the high-quality included studies. Nine high quality studies reported VTE outcomes and four reported major bleeding. The meta-analysis in those receiving IVC filters gave a pooled rate of VTE of 2.9% (95% C.I, 1.6to 4.2) and 1.1% (95%CI -0.9 to 3.1) for major bleeding compared to a rate of VTE of 1.6% (95% C.I, 0.7% to 2.5%) in those not receiving IVC filters. Six studies reported on IVC filter complications with a pooled rate of 0.6% ( 95% C.I, -0.1% to 1.1% I2= 0%).
Conclusions: Overall the rate of venous thrombosis, major bleeding and device complication rate using IVC filters for prophylaxis in bariatric surgery patients is substantial. Use of IVC filters for prophylaxis remains a concern particularly given increasing evidence that pharmacological prophylaxis is both safe and effective in these patients.
[Figure 1. QUORUM Diagram of literature search.]
[Figure 2. Meta-analysis of VTE Rate for High Quality Studies (IVC Group) ]
To cite this abstract in AMA style:
Ikesaka R, Kaur B, Crowther M, Rajasekhar A. Efficacy and Safety of Pre-Operative Insertion of Inferior Vena Cava Filter in Patients Undergoing Bariatric Surgery: A Systematic Review [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/efficacy-and-safety-of-pre-operative-insertion-of-inferior-vena-cava-filter-in-patients-undergoing-bariatric-surgery-a-systematic-review/. Accessed January 28, 2022.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/efficacy-and-safety-of-pre-operative-insertion-of-inferior-vena-cava-filter-in-patients-undergoing-bariatric-surgery-a-systematic-review/