BACKGROUND Inferior vena cava (IVC) filters are widely used for prevention of pulmonary embolism (PE). However, uncertainty persists about their efficacy and safety. OBJECTIVES The authors conducted a systematic review and meta-analysis of the published reports on the efficacy and safety of IVC filters. METHODS The authors searched PubMed, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov through October 3, 2016, for randomized controlled trials (RCTs) or prospective controlled observational studies of IVC filters versus none in patients at risk of PE. Inverse variance fixed-effects models with odds ratio (OR) as the effect measure were used for primary analyses. Main outcomes included subsequent PE, PE-related mortality, all-cause mortality, and subsequent deep vein thrombosis (DVT). RESULTS The authors' search retrieved 1,986 studies, of which 11 met criteria for inclusion (6 RCTs and 5 prospective observational studies). Quality of evidence for RCTs was low to moderate. Overall, patients receiving IVC filters had lower risk for subsequent PE (OR: 0.50; 95% confidence interval [CI]: 0.33 to 0.75); increased risk for DVT (OR: 1.70; 95% CI: 1.17 to 2.48); nonsignificantly lower PE-related mortality (OR: 0.51; 95% CI: 0.25 to 1.05); and no change in all-cause mortality (OR: 0.91; 95% CI: 0.70 to 1.19). Limiting the results to RCTs showed similar results. Findings were substantively similar across a wide range of sensitivity analyses. CONCLUSIONS Very few prospective controlled studies, with limited quality of evidence, exist regarding the efficacy and safety of IVC filters. Overall, filters appear to reduce the risk of subsequent PE, increase the risk for DVT, and have no significant effect on overall mortality.

中文翻译：

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下腔静脉过滤器预防肺栓塞

背景技术下腔静脉（IVC）过滤器广泛用于预防肺栓塞（PE）。然而，其有效性和安全性仍存在不确定性。目标作者对已发表的关于 IVC 过滤器有效性和安全性的报告进行了系统回顾和荟萃分析。方法作者在 2016 年 10 月 3 日之前在 PubMed、Cochrane 对照试验中央登记处和 ClinicalTrials.gov 中搜索了随机对照试验 (RCT) 或前瞻性对照观察性研究，这些试验是针对有 PE 风险的患者与无 IVC 过滤器相比。以优势比 (OR) 作为效应量度的逆方差固定效应模型用于主要分析。主要结局包括后续 PE、PE 相关死亡率、全因死亡率和后续深静脉血栓形成 (DVT)。结果 作者的 搜索检索到 1,986 项研究，其中 11 项符合纳入标准（6 项 RCT 和 5 项前瞻性观察性研究）。RCT 的证据质量为低至中等。总体而言，接受 IVC 过滤器的患者随后发生 PE 的风险较低（OR：0.50；95% 置信区间 [CI]：0.33 至 0.75）；DVT 风险增加（OR：1.70；95% CI：1.17 至 2.48）；非显着降低 PE 相关死亡率（OR：0.51；95% CI：0.25 至 1.05）；并且全因死亡率没有变化（OR：0.91；95% CI：0.70 至 1.19）。将结果限制在 RCT 中显示了类似的结果。在广泛的敏感性分析中，结果基本相似。结论 关于 IVC 过滤器的有效性和安全性，很少有前瞻性对照研究，证据质量有限。总体而言，过滤器似乎可以降低后续 PE 的风险，