"Death Knell" for Prophylactic Vena Cava Filters? A 20-Year Experience with a Venous Thromboembolism Guideline.

Abstract

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.

• Authors: Rathna Shenoy, Kyle W Cunningham, Samuel Wade Ross, A Britton Christmas, Bradley W Thomas, Michael J Avery, Mark L Lessne, Tanushree Prasad, Ronald F Sing
• Journal: The American surgeon (Am Surg) Vol. 85 Issue 8 Pg. 806-812 (Aug 01 2019) ISSN: 1555-9823 [Electronic] United States
• PMID: 32051064 (Publication Type: Journal Article)

Topics

• Adolescent
• Adult
• Analysis of Variance
• Female
• Humans
• Incidence
• Injury Severity Score
• Male
• Middle Aged
• Practice Guidelines as Topic
• Pulmonary Embolism (epidemiology, mortality, prevention & control)
• Registries
• Respiration, Artificial
• Retrospective Studies
• Risk Factors
• Time Factors
• Trauma Centers
• Treatment Outcome
• Vena Cava Filters (adverse effects, statistics & numerical data)
• Venous Thromboembolism (epidemiology, mortality, prevention & control)
• Venous Thrombosis (epidemiology, mortality, prevention & control)
• Ventilators, Mechanical (statistics & numerical data)
• Wounds and Injuries (complications, epidemiology)
• Young Adult