Outcomes of inferior vena cava filters in breast cancer patients with DVT: National Inpatient Sample–based comparative analysis.

Abstract

e12763 Background: Venous thromboembolism (VTE), including deep vein thrombosis (DVT), is a frequent complication of breast cancer and contributes to substantial morbidity and mortality. Inferior vena cava (IVC) filters are often used when anticoagulation is contraindicated; however, their impact on bleeding and mortality in breast cancer-associated DVT remains unclear. We evaluated the association between IVC filter placement and in-hospital outcomes in hospitalized breast cancer patients with DVT. Methods: We conducted a retrospective cohort study using the National Inpatient Sample (NIS) database. Adult patients hospitalized with breast cancer and DVT (N = 55,480) were stratified by IVC filter placement. Baseline characteristics, bleeding events (identified using ICD diagnosis and procedure codes), and in-hospital mortality were compared using descriptive statistics and multivariable logistic regression. Odds ratios (ORs), standard errors, 95% confidence intervals (CIs), and p-values are used to assess statistical significance. Results: IVC filters were placed in 1,220 patients (2.2%). Patients receiving filters were slightly younger (63.5 vs 65.1 years) with similar sex and racial distributions- White (61.9% vs 62.6%), African American (27.3% vs 22.8%). Patients were predominantly female (98.4% vs 98.5%, p = 0.88). No differences existed by hospital size, teaching status, or income quartile. Comorbidity burden and hospital characteristics were comparable between groups. Bleeding risk showed no statistical difference: gastrointestinal bleed (3.7% vs 2.7%, p = 0.35), intracranial hemorrhage (1.2% vs 2.0%, p = 0.40), major bleeding (0.4% vs 0.5%, p = 0.88), and procedure-related bleeding (1.6% vs 2.0%, p = 0.68). Overall in-hospital mortality was 8.8%, with no significant difference by IVC filter status (p > 0.05). Factors independently associated with increased mortality included age (OR 1.02, p = 0.031), sepsis (OR 4.38, p < 0.001), higher Charlson Comorbidity Index (global p < 0.001), intracranial hemorrhage (OR 2.84, p < 0.001), gastrointestinal bleeding (OR 1.64, p = 0.005), and pulmonary bleeding (OR 1.63, p = 0.015). Hormonal therapy (OR 0.46, p < 0.001) and obesity (OR 0.60, p < 0.001) were associated with lower mortality. Conclusions: In hospitalized breast cancer patients with DVT, IVC filter placement was not associated with increased in-hospital mortality or bleeding. Mortality was driven primarily by age, comorbidity burden, infection, and bleeding complications. These findings suggest that IVC filters may be used selectively in breast cancer patients with contraindications to anticoagulation without worsening short-term outcomes, while highlighting the importance of optimizing comorbidity and infection management.