Management Strategies and Clinical Outcomes in Patients with Inferior Vena Cava Thrombosis: Data from the GARFIELD-VTE Registry

O. Cohen¹, W. Ageno¹, A.E. Farjat², A.G.G. Turpie³, J.I. Weitz^3,4, S. Haas⁵, S. Goto⁶, S.Z. Goldhaber⁷, P. Angchaisuksiri⁸, H. Gibbs⁹, P. MacCallum^2,10, J. Dalsgaard Nielsen¹¹, G. Kayani², S. Schellong¹², H. Bounameaux¹³, L.G. Mantovani^14,15, P. Prandoni¹⁶, A.K. Kakkar^2,17, on Behalf of the GARFIELD-VTE Investigators

¹University of Insubria, Department of Medicine and Surgery, Varese, Italy, ²Thrombosis Research Institute, London, United Kingdom, ³McMaster University, Hamilton, Canada, ⁴Thrombosis and Atherosclerosis Research Institute, Hamilton, Canada, ⁵Formerly Technical University of Munich, Munich, Germany, ⁶Tokai University, Department of Medicine (Cardiology), Tokai, Japan, ⁷Harvard Medical School, Boston, United States, ⁸Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, ⁹Alfred Hospital, Melbourne, Australia, ¹⁰Queen Mary University of London, London, United Kingdom, ¹¹Copenhagen University Hospital, Copenhagen, Denmark, ¹²Municipal Hospital Dresden, Dresden, Germany, ¹³University Hospital of Geneva, Faculty of Medicine, Geneva, Switzerland, ¹⁴IRCCS Multimedica, Milan, Italy, ¹⁵University of Milano, Bicocca, Italy, ¹⁶Arianna Foundation on Anticoagulation, Bologna, Italy, ¹⁷University College London, London, United Kingdom

Abstract Number: PB2308

Meeting: ISTH 2020 Congress

Theme: Venous Thromboembolism and Cardioembolism » VTE Epidemiology

Background: Thrombosis of the inferior vena cava (IVC) is a rare form of deep venous thrombosis (DVT). Optimal treatment strategies and clinical outcomes are not well established.

Aims: Compare the baseline characteristics, treatment strategies, and 12-month clinical outcomes of patients with lower extremity DVT (LEDVT) with and without IVC thrombosis enrolled in the Global Anticoagulant Registry in the FIELD – Venous Thromboembolism (GARFIELD-VTE).

Methods: GARFIELD-VTE (ClinicalTrials.gov: NCT02155491) is a global, prospective, non-interventional study of real-world treatment practices. Of the 10,870 patients with objectively confirmed VTE enrolled between May 2014 and January 2017, 7,746 were eligible for analysis in this study.

Results: One-hundred IVC thrombosis patients (all with concomitant LEDVT) and 7,646 LEDVT patients with no IVC involvement were compared. IVC thrombosis patients were younger (51.9 vs. 59.8 years), more frequently had active cancer (23.0% vs. 7.5%) or a history of cancer (21.0% vs. 10.2%), and less frequently had recent trauma or surgery.
At baseline, a higher proportion of patients with IVC thrombosis received thrombolysis (11.3% vs 3.8%) or surgical mechanical interventions (4.1% vs. 1.4%) than those without. Patients with IVC thrombosis more frequently received parenteral anticoagulants alone (37.1% vs. 16.4%), and less frequently received vitamin K antagonists (24.7% vs. 32.2%) or direct oral anticoagulants (± parenteral therapy) (35.0% vs. 48.7%). Treatment duration over 12 months of follow-up was similar (Figure 1). The rate of all-cause mortality was higher in patients with IVC thrombosis (16.6 vs. 6.8 per 100 person-years), however the proportion of cancer-associated deaths was comparable (51.9% vs. 57.1%). Rates of VTE recurrence (4.9 vs. 5.4 per 100 person-years) and bleeding (7.4 vs. 10.3 per 100 person-years) were similar (Table 1).

Conclusions: Patients with IVC thrombosis are younger, and have higher all-cause mortality rates than LEDVT patients, only partly attributable to malignancy.

[Figure 1. Anticoagulation treatment patterns over 12 months’ follow-up ]

[Table 1: 12-month clinical outcomes.]

To cite this abstract in AMA style:

Cohen O, Ageno W, Farjat AE, Turpie AGG, Weitz JI, Haas S, Goto S, Goldhaber SZ, Angchaisuksiri P, Gibbs H, MacCallum P, Dalsgaard Nielsen J, Kayani G, Schellong S, Bounameaux H, Mantovani LG, Prandoni P, Kakkar AK, on Behalf of the GARFIELD-VTE Investigators . Management Strategies and Clinical Outcomes in Patients with Inferior Vena Cava Thrombosis: Data from the GARFIELD-VTE Registry [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/management-strategies-and-clinical-outcomes-in-patients-with-inferior-vena-cava-thrombosis-data-from-the-garfield-vte-registry/. Accessed November 29, 2023.

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