The Increasing Use of Vena Cava Filters in Adult Trauma Victims: Data From the American College of Surgeons National Trauma Data Bank

Abstract

VCF insertion has increased significantly during the past 10 years in trauma patients reported to the National Trauma Data Bank. The lack of an evidence-based guideline for their use has resulted in a wide variation in practice. Such variation in practice indicates the need for a consensus conference or a multicenter prospective clinical trial to determine their role in trauma patients.

Thromboembolic events and spinal surgery

“…Although its use is associated with a trend of reducing PE-related mortality in highrisk patients compared to other trauma patients, the studies that show the benefit of prophylactic or therapeutic IVCF insertion are retrospective analyses performed at single institutions and are considered level III evidence. 12 A four-fold increase (0.3-1.2%) from 1994 to 2002 in the placement of IVCF was noted in the American College of Surgeons National Trauma Data Bank. 12 Because the rate of IVCF insertions was greater than the number of reported DVT, it appeared that more IVCF were being placed prophylactically.…”

“…12 A four-fold increase (0.3-1.2%) from 1994 to 2002 in the placement of IVCF was noted in the American College of Surgeons National Trauma Data Bank. 12 Because the rate of IVCF insertions was greater than the number of reported DVT, it appeared that more IVCF were being placed prophylactically. However, IVCF are not without complications.…”

“…[2][3][4][5][6][7][8][9][10] Mechanical prophylaxis alone is often not sufficient, 11 whereas anticoagulation therapy carries a potential risk of bleeding complications. 12,13 The incidence of thromboembolic events after spinal surgery remains unclear. 1 The lack of published data leads to variability in thromboembolic prophylaxis.…”

Prevention of Venous Thromboembolism in Individuals with Spinal Cord Injury: Clinical Practice Guidelines for Health Care Providers, 3rd ed.

“…The rate of IVC filter insertion in trauma patients has increased exponentially, in large part related to the greater use of retrievable filters (Antevil, 2006;Shackford, 2007;Cherry, 2008;Spate, 2008;Yunus, 2008;Knudson, 2011). However, there is wide variation in IVC filter insertion rates across trauma centers, which cannot be accounted for by patient VTE risk.…”

“…In fact, there are no randomized trials of IVC filter use as primary thromboprophylaxis in any patient group. Numerous studies and a meta-analysis of prospective studies report no difference in the rates of PE among trauma patients with and without a prophylactic IVC filter (Velmahos, 2000:140;Girard, 2003;Antevil, 2006;Shackford, 2007;Cherry, 2008;Knudson, 2011;Kidane, 2012). Another meta-analysis reported a reduction in PE (but not in mortality) in trauma patients with use of prophylactic IVC filters; the number needed to treat to prevent one nonfatal PE with IVC filters was between 109 and 962 .…”