Abstract Body: Introduction
Managing acute pulmonary embolism (PE) in high-risk patients with contraindications to anticoagulation (e.g., cancer, trauma, surgery) is challenging. Inferior vena cava filters (IVCFs) are commonly used as an alternative, yet their benefits and risks remain controversial. Current Society of Interventional Radiology (SIR) guidelines (2020) are based on limited data from only two studies. This meta-analysis consolidates data from eleven studies to clarify IVCF effects on mortality, PE recurrence, and deep vein thrombosis (DVT) recurrence.

Hypothesis
IVCF use in high-risk PE patients with anticoagulation contraindications would increase mortality and recurrent DVT rates without significantly reducing PE recurrence.

Methods
A systematic review and meta-analysis were conducted using PubMed, Embase, and Cochrane Library databases, including studies up to October 2024. We analyzed studies comparing high-risk patients with anticoagulation contraindications (transient or permanent) who received IVCFs against those who did not. Primary outcomes were all-cause mortality, PE recurrence, and DVT recurrence. Data extraction and quality assessment followed standardized protocols, with hazard ratios (HR) and odds ratios (OR) calculated using a random-effects model.

Results
Eleven observational studies (n=186,109; IVCF=56,080) were included. IVCF use was associated with increased overall all-cause mortality (HR = 1.21 [95% CI: 1.07–1.36]) with long-term mortality (>180 days) showing considerably higher mortality HR=1.33 [95% CI 1.04-1.71] observed on subgroup analysis. IVCF use significantly increased DVT recurrence OR=1.58 [95% CI: 1.20 –2.08], while the recurrence of PE was not significantly affected (p = 0.4).

Conclusion
IVCF use in high-risk PE patients with anticoagulation contraindications is associated with increased all-cause mortality and DVT recurrence, but it does not significantly reduce PE recurrence. These findings highlight the importance of exploring anticoagulation when feasible and suggest the need for cautious IVCF use, particularly non-permanent or retrievable options. Further randomized trials are essential to validate these findings and address evidence heterogeneity.