Vena Cava Filter Placement Research Articles

Thrombotic Risk Associated with Inferior Vena Cava Filter Placement in Patients with Heparin-Induced Thrombocytopenia

PurposeThis study sought to define thromboembolic risk and mortality in patients with heparin-induced thrombocytopenia (HIT) undergoing inferior vena cava filter (IVCF) placement, in light of the American Society of Hematology’s 2018 guidelines against routine use of IVCFs in this population. MethodsA total of 26 patients with HIT who received IVCFs were retrospectively reviewed, and the outcomes of this group were compared with those of 4,707 controls with either HIT or IVCFs alone and with reported outcomes in prior studies. ResultsThe patient group demonstrated 6- and 12-month mortality rates of 26.9% and 30.8%, respectively, which did not differ significantly from those of the control groups and were in line with published mortality rates in the literature. The measured thromboembolic risk of 19.2% in the patient group was also within the range of published rates for patients with HIT or IVCF alone. ConclusionsIVCF placement did not significantly increase the risk of thromboembolism or death in patients with HIT and may be a viable option in the subset of these patients who are not candidates for anticoagulation.

Argatroban and ultrasound-facilitated thrombolysis with alteplase in a patient with bilateral pulmonary embolism and history of heparin-induced thrombocytopenia: A case report

A 58-year-old female was admitted to the hospital with bilateral pulmonary embolism (PE) with right heart strain. Her medical history included a previous PE resulting in thrombolysis and inferior vena cava filter placement, heparin-induced thrombocytopenia, morbid obesity, and chronic pain that was treated with an epidural injection 2 weeks prior to admission. This case is unusual due to the need for alternative anticoagulation management during thrombolysis in a patient with a heparin allergy who was at increased risk for bleeding. She was initiated on argatroban to achieve therapeutic aPTTs before receiving both mechanical thrombectomy and alteplase through ultrasound-facilitated catheter-directed thrombolysis. The argatroban was reduced to a flat rate of 0.5 mcg/kg/ min during thrombolysis and was subsequently increased to achieve therapeutic aPTTs upon completion of thrombolysis. The patient was transitioned from argatroban to apixaban for lifelong anticoagulation.

Impact of Access Site Choice on Outcomes of Inferior Vena Cava Filter Placement

Limited studies have evaluated optimal access site choice during placement of inferior vena cava (IVC) filters. In this study, we aim to compare the outcomes of IVC filter placement between femoral and internal jugular vein access sites.

Successful IVC thrombus extraction with the AngioVac device following five vessel coronary artery bypass graft: a case report

BackgroundInferior vena cava thrombosis is cited to be a complication of inferior vena cava filter placement and post coronary artery bypass surgery. Often only mild symptoms arise from these thrombi; however, due to the chronic nature of some thrombi and the recanalization process, more serious complications can arise. Although anticoagulation remains the gold standard of treatment, some patients are unable to be anticoagulated. In this case, we present a 65-year-old male who underwent IVC filter placement and open-heart surgery who later developed extensive femoral and iliocaval thrombosis leading to right heart failure, which required thrombus extraction with an AngioVac suction device.Case presentationWe present a 65-year-old male who presented with bilateral pulmonary emboli with extensive right lower extremity deep vein thrombosis. Upon investigation he had ischemic heart disease and underwent a five-vessel coronary artery bypass for which he had an IVC filter placed preoperatively. On post operative day 3 to 4, he was decompensated and was diagnosed with an IVC thrombus. He progressed to right heart failure and worsening cardiogenic shock despite therapeutic anticoagulation and was taken for a suction thrombectomy using the AngioVac (AngioDynamics, Latham, NY) aspiration thrombectomy device. The thrombectomy was successful and he was able to recover and was discharged from the hospital.ConclusionDespite being a rare complication, IVC thrombosis can have detrimental effects. This case is an example of how IVC thrombus in the post-operative setting can lead to mortality. The gold standard is therapeutic anticoagulation but despite that, this patient continued to have worsening cardiogenic shock. Other therapies have been described but because of its rarity, they are only described in case reports. This case shows that the AngioVac device is a successful treatment option for IVC thrombus and can have the possibility of future use.

Efficacy of Uterine Artery Embolization for Treatment of Anticoagulant-Associated Abnormal Uterine Bleeding

Data regarding uterine artery embolization (UAE) to specifically treat anticoagulant-associated iatrogenic abnormal uterine bleeding (AUB-I) are sparse. This manuscript aimed to quantify the effectiveness of UAE in treating this subset of patients. Retrospective case series. Academic hospital serving a large minority-majority population. Twenty-four patients with AUB-I that was provoked or aggravated by the initiation of anticoagulation therapy. Treatment of anticoagulant-associated AUB-I that failed medical management or was acute with UAE rather than inferior vena cava filter placement and hysterectomy. An imaging database search was performed to identify patients who underwent UAE for anticoagulant-associated AUB-I from May 2011 to July 2020. Medical and radiologic records were reviewed. Short- and long-term outcomes were obtained to date, ranging from 10 months to 10 years after the procedure. In total, 24 patients were identified, ranging in age from 35 to 54 (mean 44.9) years. Venous thromboembolic disease was the most common (92%) indication for anticoagulation. At presentation, 14 patients (58%) were anticipated to require lifelong anticoagulation. Most UAE procedures (54%) occurred within 10 days of anticoagulation initiation. Before UAE, 17 patients (71%) attempted and failed medical management, myomectomy, or endometrial ablation to control bleeding. After UAE, 21 patients (88%) experienced substantial improvement or resolution of AUB and continued anticoagulation therapy. Three patients (14%) did not experience improvement and were treated with hysterectomy. Amenorrhea immediately after UAE occurred in 1 patient at age 45. UAE was an effective tool in the management of anticoagulant associated AUB-I in this cohort, resulting in decreased bleeding while allowing the continuation of anticoagulation therapy, with high rates of uterine preservation and preserved menses.

Incidence of Venous Thromboembolism in Korea from 2009 to 2013

Incidence of venous thromboembolism (VTE) in Asian population is known to be significantly lower than that in Western population. However, Recent studies from Asia have indicated that the incidence rate of VTE is as high as that in Western population under certain circumstances such as surgery, suggesting that VTE has become a disease of major concern in Asian population. Therefore, data regarding the incidence of VTE and annual change in its incidence are of a crucial importance to understand the influence of VTE on social and medical aspects of Asian population at present and in the future.The objective of the present study was to evaluate annual age- and sex- adjusted incidence rate (ASR) of VTE from 2009 to 2013 in South Korea. In addition, annual change in pattern of VTE treatment over the study period was estimated.South Korea has a compulsory public health insurance coverage system and the National Health Insurance (NHI) service basically covers the whole population living in Korea. Health Insurance Review and Assessment Service (HIRA) is a government-operated organization that builds review and quality assessment system for claims for NHI. All claims data that healthcare service providers submit to HIRA to be reimbursed for a service provided to patient are collected by HIRA, making a nationwide population study feasible. Using the HIRA database, VTE cases from 2009 to 2013 were identified. A VTE case was defined if both diagnostic and medication codes were identified simultaneously in a patient. Coexisting medication codes for unfractionated heparin, low-molecular-weight heparin (LMWH), or direct oral anticoagulant (DOAC; rivaroxaban) were mandatory to verify accurate detection of the VTE. To analyze pattern of VTE treatment, all medical codes of anticoagulants approved for VTE treatment in Korea prescribed within 6 months after the time of VTE diagnosis were collected. In addition, codes of procedures including thrombectomy, thromboplasty, thrombolysis, and placement of inferior vena cava filter recorded from -1 to +6 months of the time of VTE diagnosis were searched. The proportion of cancer-associated VTE, who had diagnostic codes of both cancer and VTE was analyzed.Among 63,184 annual index cases of VTE from 2009 January to 2013 December, incidence rate of VTE was increased yearly. It was significantly higher in older population compared to that in younger population and higher in females compared to that in males. In 2009, ASRs of VTE, deep vein thrombosis (DVT), and pulmonary embolism (PE) were from 21.3, 8.1, and 13.2 per 100,000, respectively. They were increased to 29.2, 12.7, and 16.6 per 100,000, respectively, in 2013 (Table).Prescription rates of warfarin and LMWH were significantly decreased with the introduction of DOAC between 2012 and 2013 (Figure). It might be influenced by benefits of lower cost of rivaroxaban reimbursed by NHI service for 6 months of treatment duration. Although ASR itself was increased, proportions of subjects who received mechanical procedures were decreased annually. Cancer associated VTE accounted for 33.1% of all VTE and they had higher relapse rate compared to those who did not have a diagnostic code of cancer (7.08% vs. 6.54%; p < 0.013).Our near a whole nationwide epidemiologic study shows that ASR of VTE in Korea has continuously increased from 2009 to 2013. The result reflects a rapid aging society, improved awareness of VTE, and improved survival of patients with cancer and other morbidities that complicate VTE. The introduction and reimbursement of DOAC resulted in significant change in the pattern of anticoagulant prescription within a short period of time. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Placement of Simultaneous Inferior Vena Cava Filter During Emergent Open Pulmonary Thromboembolectomy

Background: This study retrospectively reviewed results of simultaneous (SIM) inferior vena cava (IVC) filter and separate (SEP) IVC filter placement with open pulmonary thromboembolectomy (PTE) in pulmonary embolism and its clinical outcomes. Materials and Methods: From November 2006 to May 2014, 23 patients (14 females and 9 males; median age 58 years; range, 21–88 years) underwent emergent PTE for submassive (12) or massive (11) pulmonary embolism (PE). All had a preoperative computed tomography (CT) scan and echocardiography consistent with right ventricular (RV) strain. Mean cardiopulmonary bypass times and temperatures; chest tube outputs; length of stay; perioperative complications; and survival were compared between groups. Results: There were 13 patients in the SIM group and 10 in the SEP group. PE consisted of 14 acute (60.9%) and nine acute on chronic (39.1%). There were seven deaths (30.4%). Median follow up was 44 days (range, 2–2204 days). Follow up was 81% complete in surviving patients. Actuarial survival at one and three years was 83% for the SIM group and 43% for the SEP group, respectively. There were no differences in cardiopulmonary bypass (CPB) times and temperatures, chest tube outputs, or length of stay between groups. Using multivariable logistic regression, we found SIM was associated with increased survival (p=0.09). Further analysis showed patients &gt;55 years in the SEP group were at significantly higher risk of death (hazard ratio [HR]=7.1:1; 95% confidence interval [CI]: 1.55, 32.5, p=0.011). Conclusion: IVC filter placement can be performed simultaneously and safely at PTE. Age &gt;55 years and PTE with IVC filter placed separately were at significantly higher risk of death. A larger cohort is needed to evaluate efficacy of simultaneous IVC filter placement and PTE.

AB0786 HUGHES–STOVIN SYNDROME: A PECULIAR AUTOIMMUNE ORIGIN OF PULMONARY ANEURYSMS

Background:Hughes-Stovin Syndrome (HSS) is a rare potentially fatal vasculitis supposedly belonging to the spectrum of Behçet disease without ocular involvement. HSS tends to play by a temporal pattern, starting with thrombosis and followed by formation of pulmonary aneurysms. Since its mortality can reach 25% of cases, the early recognition and the appropriate therapy represent the major challenges.Objectives:In this report, we aimed at describing a rare case of HSS successfully treated in accordance with a prompt combined management with endovascular approach and immunosuppressive treatments.Methods:We described a Caucasian 33-year-old man presented to the Emergency Room of our Hospital with hemoptysis associated with dyspnea and chest pain, without fever and hypotension, with a 2-year history of painful genital and oral ulcers. Blood test revealed anemia, elevated white cell count with increased C-reactive protein (77 mg/L) and D-dimer (2740 ng/mL). Doppler ultrasonography of legs showed thrombosis of the left femoral vein, while CT-angiography reported multiple aneurysms of the pulmonary arteries. An early and extensive work-up for infections and autoimmunity did not document relevant abnormalities. An appropriate genetic assessment revealed the HLA-B51 positivity. The patient immediately underwent endovascular embolization with coils and plugs of the largest pulmonary aneurysm, and inferior vena cava filter placement. Then, he started methylprednisolone (1 mg/kg/day) IV for three days in association with LMWH (6000 IU/day). Prednisone (1 mg/kg/day) in combination with cyclophosphamide (100 mg daily) were started orally, with tapering of steroids within a month. At the tight follow up (1 month and 3 months later), no genital and oral ulcers nor vascular thrombosis occurred, and acute phase reactants were in normal range. The 3-month-CT angiography showed a complete resolution of the aneurysms and no new changes.Results:The peculiar diagnosis of HLAB51 positive HSS with multiple pulmonary aneurysms was made. The appropriate imaging followed by a prompt endovascular embolization of aneurysms with LMWH treatment were successfully performed. Interestingly, the oral combination therapy with corticosteroid and cyclophosphamide showed a rapid efficacy with a relevant safety profile. At the tight follow up, the young man improved significantly with clinical signs and pulmonary changes (Figure 1 next page).Conclusion:This case is of interest because of the early recognition of such a rare disease that allowed an adequate combined radiological, vascular, and rheumatologic approach. In our case, LMWH resulted useful in preventing the pulmonary embolism, despite the use of anticoagulants is still debated in HSS. Moreover, the endovascular embolization let a less invasive approach to surgery without the need for multiple surgical procedures. For the first time, we documented that oral cyclophosphamide showed an early efficacy as a first line therapy of a HLA-B51 HSS.

Association of Vena Cava Filters and Catheter-Directed Thrombolysis for Deep Vein Thrombosis With Hospital Readmissions

OBJECTIVES: The objective was to evaluate all-cause 30 days readmission rate and its association with inferior vena cava filters (IVCF) placement and catheter-directed thrombolysis (CDT) in patients with proximal and caval DVT. BACKGROUND: The rehospitalization rates and its predictors in acute proximal DVT have not been well characterized, including the impact of IVCF placement and CDT.METHODS: Patients with index hospitalization for acute proximal lower extremity DVT were evaluated for unplanned readmission rates at 30 days using Nationwide Readmission Database from 2016 to 2017. We used Cox proportional hazard model to determine the predictors of 30-days readmissions and its association with IVCF and CDT use. RESULTS: 58,306 adult patients were identified with an index hospitalization for acute proximal DVT. 533 patients died during the index admission or within 30 day from initial discharge. The unplanned 30-day rehospitalization rate among survivors of initial hospitalization was 14.7% (95% confidence interval [CI]: 14.5-15.0%). In multivariable analysis, only CDT was associated with a lower hazard for rehospitalization (HR 0.77, 0.71-0.84), whereas IVCF placement (HR 1.26, P<0.001, 95% CI 1.19-1.34), malignancy (HR 1.45, P<0.001, 95% CI 1.34-1.57), and length of stay more than 5 days (HR 1.39, P<0.001, 95% CI 1.33-1.46) were associated with higher readmission rates. CONCLUSIONS: The 30-day unplanned rehospitalization rate continues to be high in patients with acute proximal DVT. CDT was associated with lower rehospitalization rates, while IVCF placement was associated with increased rehospitalization rates. FUNDING STATEMENT: This research was funded by the Division of Cardiovascular Disease, Temple University Hospital. DECLARATION OF INTERESTS: Dr Bashir has equity interest in Thrombolex Inc. Dr. Bikdeli reports that he is a consulting expert, on behalf of the plaintiff, for litigation related to specific brand models of IVC filters. Dr. Anthony J. Comerota is an unpaid member of the Scientific Advisory Board of Thrombolex, Inc. No other disclosures are reported. ETHICS APPROVAL STATEMENT: NRD is publicly available and contains deidentified patient information, hence, the study was exempted from institutional review board assessment.

Abstract No. 54 Utilization and efficacy of prophylactic inferior vena cava filter placement in severely injured trauma patients at high thromboembolic event risk: a National Trauma Data Bank Study

To assess utilization of prophylactic inferior vena cava filter (IVCF) placement and associated outcomes of pulmonary embolism (PE), deep venous thrombosis (DVT), and overall mortality in severely injured trauma patients at high thromboembolic event risk. Using the National Trauma Data Bank (NTDB) from 2008 to 2015, adult patients with severe orthopedic, spinal cord, or intracranial injuries (Injury Severity Score [ISS] ≥15) admitted to level I-IV trauma centers were identified. IVCF filters placed within 48 hours of admission and before any lower extremity venous ultrasound examinations were deemed prophylactic. Predictors of prophylactic IVCF receipt were determined using logistic regression. Associations between prophylactic IVCF placement, PE, DVT, and in-hospital mortality were also estimated with separate logistic regression models adjusting for year of injury, injury type, age, sex, ISS, race, and geographic region. Of 549,593 unique trauma admissions meeting inclusion criteria, 5,537 (1.0%) underwent prophylactic IVCF placement. Utilization decreased over time (OR: 0.80, P < 0.01). Predictors of prophylactic IVCF receipt were combined intracranial, orthopedic, and spinal cord injuries (OR: 5.01, P < 0.01), northeast region (OR: 2.50, P< 0.01), and increasing ISS score (OR: 1.04 per 1 unit increase, P < 0.01). Overall PE prevalence increased minimally (0.98% in 2008 to 1.08% in 2015). Prophylactic IVCF placement was associated with increased occurrence of PE (OR: 1.48, P < 0.01) and DVT (OR: 2.36, P < 0.01), but decreased overall mortality compared to similar non-IVCF cohorts (OR: 0.69, P < 0.01). In patients undergoing prophylactic IVCF with isolated intracranial, orthopedic, and spinal injuries, estimated probabilities of death decreased 29.1%, 30.5%, and 30.7%, respectively. Prophylactic IVCF placement in severely injured trauma patients at high thromboembolic event risk was associated with decreased overall mortality, but increased rates of PE and DVT. Prospective evaluation of prophylactic IVCF placement in severely injured trauma patients is warranted.

Abstract No. 528 Modeling socioeconomic and demographic variables affecting inferior vena cava filter placement and retrieval: a single-institution retrospective review at a safety net hospital from 2012 to 2019

This study was conducted to investigate the factors affecting IVC filter retrieval rates at a county hospital with the intent to supplement guidelines for IVC filter placement. We conducted a retrospective review of all patients who underwent IVC filter placement at our institution between January 2012 and December 2019. During the study period 539 patients had IVC filters placed; of those, 405 (148 women, 257 men, median age 51 years), had sufficient data and were over the age of 18. The following variables were collected: age, gender, BMI, ZIP code, marital status, insurance type, primary language spoken, length of hospital stay, indication type (classic, expanded, or prophylactic)1, presence of trauma, discharge destination (home, long-term nursing, or other), date of IVC filter retrieval (if applicable), and the presence of risk factors (smoking history, alcohol use, hypertension, diabetes, venous thromboembolism). The patients’ ZIP codes were used in conjunction with US census data on median household income by ZIP code to estimate their socioeconomic status (SES). SES was log transformed to correct for non-normality. Variables that showed a significant difference between those who had their IVC filters removed and those who did not were tested for inclusion in a multivariate logistic regression model. Inclusion criteria was based on statistical significance at α ≤ .05 for each independent variable. All insurance data were included as dummy variables in a set with “uninsured” as the reference category. Inclusion of these covariates in this model predicts 31.5% of the variation in IVC filter retrieval rate (Nagelkerke R-squared = .315). The Table displays the patient characteristics that statistically significantly contribute (α ≤ .05) to predicting IVC filter retrieval rates. Various patient characteristics including demographics, comorbidities, insurance coverage, and clinical indications are predictive of IVC filter retrieval rates. These must be considered when developing protocol on IVC filter placement indications at institutions with certain patient populations, such as a county hospital.Tabled 1Odds Ratio95% Confidence IntervalP Value Age0.980.97–0.99.011 Ln SES2.21.15–4.18.017 Trauma3.11.74–5.4.000 Diabetes0.310.15–0.63.001 VTE0.530.31–0.9.018Insurance Commercial or self-pay1.970.94–4.12.072 Medicaid2.11.0–4.3.049 Medicare1.10.43–2.6.921Model AUC0.80.76–0.85Nagelkerke R-squared0.315AUC = area under the receiver operating characteristic curve; SES = estimated median household income. *** Open table in a new tab

Abstract No. 543 Femoral, venous, or brachial venous access for Option vena cava filter placement: is there a difference in post-deployment filter tilt?

Abstract No. 543 Femoral, venous, or brachial venous access for Option vena cava filter placement: is there a difference in post-deployment filter tilt?

Abstract No. 189 Characteristics of patients who died or underwent hospice care after inferior vena cava filter placement

Abstract No. 189 Characteristics of patients who died or underwent hospice care after inferior vena cava filter placement

Abstract No. 80 Inferior vena cava filter placement and retrieval in pediatric patients: a multicenter retrospective analysis

Abstract No. 80 Inferior vena cava filter placement and retrieval in pediatric patients: a multicenter retrospective analysis

Abstract No. 111 Retrospective review of complications and outcomes of 603 Option Elite inferior vena cava filter placements

To retrospectively identify the frequency of complications, removals, and clinical outcomes in patients in whom Option Elite inferior vena cava (IVC) filters were placed, and their associated clinical and procedural factors.

Abstract No. 104 National trends in inferior vena cava filter placement and retrieval: how are we doing?

Prior studies demonstrate a marked increase and subsequent decrease in the number of inferior vena cava (IVC) filters placed over the last several decades. The aim of this analysis was to evaluate national recent trends in placement and removal of IVC filters in the Medicare population using the most recent data available.

Feasibility study of hand-carried ultrasound-guided retrievable inferior vena cava filter placement

BackgroundWith the development of ultrasonic diagnostic techniques in recent years, ultrasound-guided placement of inferior vena cava (IVC) filters has been widely used in clinics, and satisfactory results have been achieved. Our study aims to observe the accuracy of hand-carried ultrasound-guided retrievable vena cava filter placement, evaluate the feasibility and safety of this new method, and provide a scientific and effective interventional method and clinical data to prevent acute pulmonary embolism (PE) after battle injury of limbs.MethodsTwo hundred patients with post-traumatic thrombosis of the extremities were enrolled. The renal vein was located under the guidance of hand-carried ultrasound. The retrievable filter was fixed 1–2 cm below the opening of the renal vein. The self-expanding filter was used after the filter’s position was confirmed by injecting the contrast agent under the digital subtraction angiography (DSA) fluoroscopy.ResultsAll the 200 patients underwent the operation successfully. The position of the hand-carried ultrasound localizer was consistent with the DSA localizer. All the filters were expanded smoothly. No complications related to the operation occurred.ConclusionsThe study concluded that the hand-carried ultrasound-guided retrievable vena cava filter placement has a high success rate and can prevent acute PE after limbs’ battle injury.

Evaluation of inferior vena cava filter placement during percutaneous endovenous intervention for proximal lower extremity deep venous thrombosis: a retrospective study

Background Anticoagulant therapy is still the prevalent treatment for venous thromboembolism. In the new era of percutaneous endovenous intervention, there is a progressive increase in the use of percutaneous endoluminal clot dissolution techniques such catheter-directed thrombolysis (CDT) and mechanical aspiration thrombectomy devices because of their short-term advantages. Prophylactic deployment of inferior vena cava (IVC) filter during percutaneous endovenous therapy for lower extremity deep venous thrombosis (DVT) is still a debatable issue. Objectives The aim of our study is to assess retrospectively the frequency of embolization and the need for deployment of a retrievable IVC filter during endovenous treatment of proximal lower extremity DVT using percutaneous CDT and AngioJet pharmacomechanical thrombectomy (PMT) techniques. Settings and design This was a retrospective study. Patients and methods Percutaneous endoluminal clot dissolution using either CDT or AngioJet PMT for proximal lower extremity DVT was performed on 56 patients (59 limbs) of 187 patients diagnosed with proximal acute/subacute DVT in the Vascular Surgery Department of the study hospitals. An IVC filter was deployed in 29 patients before or during the procedure. Results Of 56 patients who were treated for proximal DVT with clot debulking procedures, the IVC filter was prophylactically deployed in 26 (46.4%) patients. Trapped thrombus in the deployed filters as shown on venocavography was observed in 9/26 (34.6%) filters deployed prophylactically, with an overall rate of thrombus embolization during percutaneous endovenous thrombus dissolution techniques being 12/56 (21.4%) patients. Conclusion CDT could be performed safely and effectively without routine prophylactic IVC filter placement in the treatment of acute DVT. Selective filter placement may be considered in patients undergoing PMT or patients with more proximal thrombus patterns with multiple risk factors.

Self-centering of the Cook Celect inferior vena cava filter

A patient who underwent placement of an inferior vena cava (IVC) filter before total knee arthroplasty with a history of venous thromboembolism following knee replacement 10 years prior. Difficulty releasing the filter during delivery resulted in approximately 17° of medial tilt of the filter apex. Follow-up computed tomography after arthroplasty 4 months after placement demonstrated that the filter self-centered in the IVC with subsequent straightforward retrieval.

Prophylactic placement of inferior vena cava filters and the risk of death or venous thromboembolism in severe trauma patients: a retrospective study comparing two hospitals with different approaches.

BackgroundProphylactic use of inferior vena cava filters to prevent pulmonary embolism in trauma is controversial. The practice varies between hospitals and countries, in part due to conflicting evidence and guidelines.PurposeTo compare the effects of pulmonary embolism, deep venous thrombosis and mortality in two hospitals using prophylactic inferior vena cava filter placement or prophylactic anticoagulation alone.Material and MethodsPatients presenting with severe trauma were recruited from two level-1 trauma centres between January 2008 and December 2013. Recruited patients from an US hospital having prophylactic inferior vena cava filter inserted were compared to a Scandinavian hospital using prophylactic anticoagulation alone. Inclusion criteria were age >15 years, Injury Severity Score >15 and survival >24 h after hospital admission. Patients with venous thromboembolism diagnosed prior to inferior vena cava filter placement were excluded. A Cox proportional hazard regression model was used with adjustment for immortal time bias and predictor variables.ResultsIn total, 951 patients were reviewed, 282 from an US hospital having inferior vena cava filters placed and 669 from a Scandinavian hospital without inferior vena cava filters. The mean age was 45.9 vs. 47.4 years and the mean Injury Severity Score was 29.8 vs. 25.9, respectively. Inferior vena cava filter placement was not associated with the hazard of pulmonary embolism (Hazard ratio=0.43; 95% confidence interval (CI) 0.12, 1.45; P=0.17) or mortality (Hazard ratio=1.16; 95% CI 0.70, 1.95; P=0.56). However, an increased rate of deep venous thrombosis was observed with inferior vena cava filters in place (Hazard ratio=3.75; 95% CI 1.68, 8.36; P=0.001).ConclusionIn severely injured trauma patients, prophylactic inferior vena cava filter placement was not associated with pulmonary embolism or mortality. However, inferior vena cava filters were associated with increased rate of deep venous thrombosis.