Risk factors for inferior vena cava filter thrombosis in traumatic fracture patients with deep venous thrombosis of lower extremity: A single-center experience

Abstract

Objective To explore the risk factors for inferior vena cava filter (IVCF) thrombus in orthopedic trauma patients who underwent filter placement with ongoing anticoagulation in clinical settings. Methods We retrospectively analyzed clinical data from fracture patients with lower extremity acute deep vein thrombosis (DVT) implanted with an IVCF admitted to Tianjin Hospital from January 2017 to December 2019. Potential risk factors, such as gender, age, diabetes, hypertension, fracture sites, thrombus location, free-floating thrombus, filter type, Injury Severity Score (ISS), and postoperative D-dimer values, were analyzed by the Chi-square test, t-test, logistic regression, and receiver operating characteristic (ROC) curve analysis. Results A total of 662 patients were included in our study, and filter-related thrombosis was present in 67 (10.1%) patients. No significant differences were observed in age, gender, hypertension, diabetes, fracture site, free-floating thrombus, filter type, indwelling time, and postoperative D-dimer level. Thrombus location and ISS were significantly different ( p < 0.05). Popliteal DVT (P-DVT) (odds ratio [OR]: 2.130, p = 0.018) and ISS (OR: 1.135, p = 0.000) were associated with filter thrombus. Patients with P-DVT were prone to a small filter thrombus (OR: 3.231, p = 0.037). From the ROC curve analysis, the diagnostic value of ISS was 24.5 and 26.5 for patients with filter and massive filter thrombus, respectively. Conclusion Thrombus location and ISS were independent risk factors for filter thrombus in patients with traumatic fractures. P-DVT had a higher potential to result in a small filter thrombus and an ISS value >26.5, which was considered a significant massive filter thrombus predictor.

Acute caval thrombosis leading to obstructive shock in the early post insertion period of an inferior vena cava filter: a case report and literature review

“…Furthermore, the likelihood of lower limb DVT embolization inducing the development of PE is approximately 0.93%, and the mortality rate associated with PE varies between 0.38 and 13.8%, making it a significant contributor to perioperative mortality [2]. Placement of an IVCF is crucial for preventing PE [3], and it has been demonstrated to reduce the occurrence rate of PE from 60 to 70% to 0.9-5.0% [4]. An analysis of the United States National Trauma Database revealed a negative correlation between prophylactic IVCF insertion in orthopaedic trauma patients at higher risk for VTE and overall in-hospital mortality rates [5].…”

Efficacy of percutaneous mechanical thrombus removal in acute lower extremity deep venous thrombosis

“…Currently, the common treatment is CDT, which can be precisely performed in the affected deep vein when treating DVT, and the thrombolytic drugs can be delivered directly to the thrombus site, thus ensuring that the local effect is more direct and the effect of thrombus dissolution is more significant. CDT treatment can also control the effect and safety of treatment by adjusting the drug dose to avoid the adverse effects of drugs on the whole body[ 23 , 24 ]. However, there are other problems in the treatment process, such as longer bed rest time, poorer patient tolerance, use of the urokinase dose Deng and contraindications to thrombolysis in some patients[ 25 , 26 ].…”

Clinical outcomes of AngioJet pharmacomechanical thrombectomy versus catheter-directed thrombolysis for the treatment of filter-related caval thrombosis

“…A high incidence of DVT has been reported in trauma patients, especially those with lower-limb fractures. With transient trauma contraindicating anticoagulant use, temporary perioperative IVC filter placement is the best prophylactic option for these patients[ 12 , 21 ]. IVC filter placement, however, may lead to numerous complications[ 22 ].…”

“…IVC filter placement, however, may lead to numerous complications[ 22 ]. Filter-related thrombosis is one of the complications after implantation, with an incidence of approximately 10% in these patients[ 12 ]. Moreover, filter-related thrombosis also causes serious complications, such as caval occlusion or shock[ 14 , 23 ].…”