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The role of prophylactic vena cava filters (pVCFs) in trauma patients remains controversial. After 20 years of data collection and experience, we reviewed our venous thromboembolism guideline for the efficacy of pVCFs in preventing pulmonary embolism (PE). A retrospective cohort study was performed using our Level I trauma center registry from January 1997 thru December 2016. This population was then divided by the presence of pVCFs. Univariate analysis was performed comparing the incidence of PEs, deep vein thrombosis, and mortality between those with and without a pVCF. There were 35,658 patients identified, of whom 2 per cent (n = 847) received pVCFs. The PE rate was 0.4 per cent in both groups. The deep vein thrombosis rate for pVCFs was 3.9 per cent compared with 0.6 per cent in the no-VCF group (P < 0.0001). Given that there was no difference in the rates of PEs between the cohorts, the subset of patients with a PE were analyzed by their risk factors. Only ventilator days > 3 were associated with a higher risk in the no-pVCF group (0.2 vs 1.5%, P = 0.033). pVCFs did not confer benefit reducing PE rate. In addition, despite their intended purpose, pVCFs cannot eliminate PEs in high-risk trauma patients, suggesting a lack of utility for prophylaxis in this population.
It is well known that trauma patients are at an increased risk for the development of venous thromboembolism (VTE). Trauma patients considered to be at high risk can develop deep venous thrombosis (DVT) and pulmonary embolisms (PEs), with incidence up to 40 per cent and 20 per cent, respectively.1, 2 Early anticoagulation has been associated with a 5 per cent risk of VTE, but a delay beyond four days was found to have three times that risk.3 However, in polytrauma patients, VTE chemoprophylaxis is often delayed because of concomitant solid organ injury or intracranial hemorrhage, resulting in an increased risk of VTE and PEs. Over the last 25 years, there has been an abundance of literature studying the use of prophylactic vena cava filters (pVCFs) in the trauma population. in this setting, a pVCF is defined as the insertion of an inferior vena cava filter and no identified DVT or PE.
Prior work has shown a possible benefit to...