Effect of inferior vena cava filters on pulmonary embolism-related mortality and major complications: a systematic review and meta-analysis of randomized controlled trials.

Abstract Objectives Inferior vena cava (IVC) filters are commonly used. However, there is no clear consensus on the benefits and risks from randomized, controlled trials (RCTs). Therefore, w e aimed to investigate it. Methods PubMed and Cochrane libraries were searched from inception to 31st OCT 2019 to identify RCTs to perform meta-analyses. The primary outcome was mortality related to pulmonary embolism (PE). The secondary outcomes were overall mortality, occurrence of PE, deep vein thrombosis and major bleeding. Risk ratios were pooled using the Mantel–Haenszel method with the fixed effect mode for low heterogeneity, otherwise, with the random effect model. Risk differences were considered as a candidate of effect size if some data could not be pooled in the calculations. Results Seven articles with 1274 patients were included. There was no significant difference in mortality related to PE between the IVC filter group and the control group within 3 months (risk difference −0.01, 95% confidence interval [CI] −0.03 to 0.00, P=0.11) and during the whole follow-up time with low heterogeneity (I2=0%). The rates of new occurrence of PE within 3 months and during the whole follow-up period were lower in the IVC filter group than those in the control group (0.81% versus 5.98%, risk ratio 0.17, 95% CI 0.04 to 0.65, P=0.01; 3.2% versus 7.79%, risk ratio 0.42, 95% CI 0.25 to 0.71, P=0.001, respectively). There were no significant differences in the rates of new occurrence of deep vein thrombosis,major bleeding and mortality rates during the whole follow-up period between the groups (P>0.05). Conclusions There is insufficient evidence to conclude that IVC filters could reduce mortality. However, filters decrease the new occurrence of PE without increasing deep vein thrombosis and major bleeding.