На Medscape размещена совсем маленькая статья про ТЭЛА и кава фильтр, но цифры уж очень убедительные и статика за 10 лет 1000 госпиталей. Получается, что нестабильным пациентам (у кого был шок или ИВЛ) фильтр показан даже после тромболизиса. Какая практика сложилась в ваших больницах?
Vena Cava Filters Cut Pulmonary Embolism Fatalities in Some Patients
NEW YORK (Reuters Health) Mar 06 - Data from the National Inpatient Sample indicate that vena cava filters reduce in-hospital mortality in patients with pulmonary embolism who are unstable or who are stable and received thrombolytic therapy.
"The majority of hospitalized patients with pulmonary embolism, however, were stable and did not receive thrombolytic therapy," and the benefit is limited in this population, note the authors of the report in the American Journal of Medicine online February 6.
Dr. Paul D. Stein of St. Mary Mercy Hospital in Livonia, Michigan and colleagues point out that vena cava filters are increasingly used in patients with pulmonary embolism but their effect on mortality is not clear.
To investigate which categories of patients may or may not benefit from their use, the team used the National Inpatient Sample, which has information on roughly eight million hospital stays at approximately 1000 hospitals. The researchers used ICD-9-CM to identify patients with pulmonary embolism, deep venous thrombosis (DVT) and use of thrombolytic therapy. Patients with shock or ventilator dependence were defined as unstable.
"Patients were matched according to stability, thrombolytic therapy, and diagnosis of deep venous thrombosis," the investigators wrote.
Over a 10-year period, more than 2.1 million short-stay hospital patients were diagnosed with pulmonary embolism. The great majority (95%) were stable and did not receive thrombolytic therapy. In this group, the case fatality rate was only marginally lower with vs without a vena cava filter (7.2% vs 7.9%).
Furthermore, the mortality rate was actually higher in stable patients with DVT who received a vena cava filter (6.7% vs 5.5%), the report indicates.
There was, however, a clear-cut benefit for the relatively few stable patients who received thrombolytic therapy. Their case fatality rate was 6.4% with use of a VC filter and 15.0% without.
For unstable patients, vena cava filters were helpful whether or not they received thrombolytic therapy. Respective case fatality rates with and without VC filter use were 7.6% vs 18.0% in those undergoing thrombolysis and 33.0% vs 51.0% among those who did not receive thrombolytic therapy.
"For now, it seems prudent to consider a vena cava filter in patients with pulmonary embolism who are receiving thrombolytic therapy and in unstable patients who may not be candidates for thrombolytic therapy," Dr. Stein and colleagues advise.
However, they add, "Future prospective study with assessment of the absolute risks of filter placement in various subgroups of patients is warranted to better define in which patients a filter is appropriate."
SOURCE:
http://bit.ly/zjBjAl - это ссылка на статью в журнале
Am J Med 2012.
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