Early Placement of Prophylactic Vena Caval Filters in Injured Patients at High Risk for Pulmonary Embolism

Rodriguez, Jorge Luis; Lopez, Juliet M.; Proctor, Mary C.; Conley, Janna L.; Gerndt, Steven J.; Marx, M. Victoria; Taheri, Paul A.; Greenfield, Lazar J.

doi:10.1097/00005373-199605000-00020

Cited by 162 publications

(109 citation statements)

References 9 publications

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“…Seven studies, with a total of 1,900 patients, published between 1994 and 2009 met our search criteria ( Fig. 1) [5,7,9,15,18]. All seven were cohort studies that reported PE rates, two of which also report DVT outcomes [7,18].…”

Section: Characteristics Of Studies Includedmentioning

confidence: 99%

“…In contrast, the 2008 American College of Chest Physicians (ACCP) guidelines on the prevention of VTE recommended against the use of IVCF as primary prophylaxis in trauma patients based on Grade IC evidence (strong evidence based on observational studies) [3]. The literature on the efficacy of pIVCFs in trauma patients without VTE is controversial [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. To date, there have been no randomized controlled trials addressing the efficacy of IVCFs as VTE prophylaxis in any patient population.…”

Section: Introductionmentioning

confidence: 99%

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Pulmonary embolism prophylaxis with inferior vena cava filters in trauma patients: a systematic review using the meta-analysis of observational studies in epidemiology (MOOSE) guidelines

Rajasekhar

Lottenberg

et al. 2011

J Thromb Thrombolysis

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Prophylactic inferior vena cava filters (pIVCFs) for the prevention of pulmonary embolism (PE) are controversial. Current practice guidelines (EAST and ACCP) are based on the critical appraisal of observational studies. As a result, their recommendations are conflicting and may account for practice pattern variation. The purpose of this study is to critically review the available literature and ascertain the level of evidence both for and against the use of pIVCFs for PE prophylaxis in trauma patients. We searched PubMed and Web of Science for publications from 1950 until July 2010 that assessed the efficacy of PE prevention with pIVCFs in the trauma population. We followed the MOOSE (Meta-analysis of Observational Studies in Epidemiology) guidelines for design, implementation, and reporting. The Newcastle-Ottawa Score was used for quality and comparability assessment. Seven observational studies met inclusion criteria for this meta-analysis, representing 1,900 patients. Only one study was published in this decade. The rate of PE was statistically lower in the IVCF group compared to a matched control group without IVCFs (OR 0.21, 95% CI 0.09-0.49). There was no significant difference in DVT. Using the MOOSE criteria these results show a decreased likelihood of PE among trauma patients who receive pIVCFs. Although these results could favor the placement of pIVCFs, the lack of contemporary use of pharmacologic prophylaxis across studies does not allow us to make firm conclusions either for or against the routine use of pIVCFs. Prospective randomized trials are needed to determine the role of pIVCFs in high-risk trauma patients.

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Section: Characteristics Of Studies Includedmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pulmonary embolism prophylaxis with inferior vena cava filters in trauma patients: a systematic review using the meta-analysis of observational studies in epidemiology (MOOSE) guidelines

Rajasekhar

Lottenberg

et al. 2011

J Thromb Thrombolysis

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“…Some studies have advocated preventative (in the absence of proven deep venous thrombosis or pulmonary embolism) implantation of a vena cava filter after a trauma, on the basis that it reduces the incidence of severe thromboembolic events in these cases and because it involves temporary interruption of the vena cava [9][10][11][12] . The majority of filters are fitted with the aid of fluoroscopy, using iodine-based contrasts in specific sectors, but for patients at high risk from transportation, they can be fitted at the bedside with the aid of vascular Doppler ultrasound 13 .…”

Section: Discussionmentioning

confidence: 99%

Implante profilático e temporário de filtro de veia cava inferior no trauma

et al. 2013

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“…They suggested that long-term anticoagulant therapy should be considered after placement of a permanent filter to counterbalance this possible effect. However, a higher DVT rate was not seen in trauma patients with prophylactic filter placement compared with non-filter patients [34]. On a long-term follow-up (4-42 months), Patton et al [35] found that 26% of the patients had physical findings and duplex evidence of postphlebitic syndrome.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic Insertion of Optional Vena Cava Filters in High-Risk Trauma Patients

et al. 2006

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Ab stractBackground: Vena cava interruption is a form of pulmonary embolism prophylaxis that is being used in high-risk patients who do not tolerate pharmacologic prophylaxis. Retrievable prophylactic vena cava filters (VCFs) are of particular interest for severely injured patients where the necessity for VCF is often only temporary. Methods: In a single-institution case series of consecutive patients who received prophylactic VCFs after polytrauma, between 04/1998 and 07/2004, the demographic data, injury pattern and complications were analysed. Results: Ninety-five prophylactic VCFs were placed in polytrauma patients (median ISS of 38). Median age was 38 years (range 16-80 years). Median delay between trauma and filter placement was 1 day (range 0-31 days). No complication was seen related to filter insertion or retrieval. Sixty-five VCFs (68.4%) were retrieved after 4-25 days (median 13 days). One filter migration (1.1%) was observed. Retrieval failed in two patients (3.0%). A total of 30 VCFs (31.6%) were left permanently. One nonfatal PE (1.1%) occurred 21 days after filter retrieval despite prophylaxis with LMWH. DVT developed in two patients (2.1%) including one vena caval occlusion (1.1%). Overall mortality was 7.4%. Conclusions: Early prophylactic placement of VCF in a high-risk trauma patient should be considered when anticoagulation is contraindicated. Filter insertion and retrieval is safe with a low complication rate.

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Early Placement of Prophylactic Vena Caval Filters in Injured Patients at High Risk for Pulmonary Embolism

Abstract: In spite of long-term morbidity, early prophylactic VCF placement is safe and should be considered in the prophylaxis of PE in the high-risk injured patients. This intervention may be effective in eliminating PE as a major cause of posttrauma morbidity and mortality.

Cited by 162 publications

References 9 publications

Pulmonary embolism prophylaxis with inferior vena cava filters in trauma patients: a systematic review using the meta-analysis of observational studies in epidemiology (MOOSE) guidelines

Pulmonary embolism prophylaxis with inferior vena cava filters in trauma patients: a systematic review using the meta-analysis of observational studies in epidemiology (MOOSE) guidelines

Implante profilático e temporário de filtro de veia cava inferior no trauma

Prophylactic Insertion of Optional Vena Cava Filters in High-Risk Trauma Patients

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