Abstract

Venous thromboembolism (VTE) is a frequent complication of patients who experienced major trauma and is accountable for almost 11% of deaths in those who survive at least 24 hours. Prevention of VTE is usually feasible through thromboprophylaxis and/or mechanical devices, but some trauma patients have injuries that make thromboprophylaxis impossible. Using inferior vena cava filter (IVC) is optional but it is not devoid of complications. Therefore the ASH in 2013 choosing Wisely® recommended avoiding routine usage of IVC filter. In this work our goal was to assess complications related to a single type of filter used prophylactically in trauma patients in a tertiary center and to search for risk factors associated with failure to remove the filter. The study included 136 patients aged 16 through 60 who experienced a major trauma and underwent prophylactic IVC filter insertion of type Optease at Sheba Medical Center during the years 2007-2013. The mean age of the patients was 36.7 with 79.6% men and 20.4% women. The predominant cause of injury was motor vehicle accidents (52%) and the mean Glasgow coma scale of patients when first seen by a traumatologist was 7.5. The median time from trauma to filter insertion was 2 days. Anticoagulation in prophylactic dose was started in 92.1% patients (117/127, no information for 9) once filter was inserted. The filter was removed in 68 (50%) of patients. In 13 patients the attempted filter removal was not successful for mechanical reasons. Nine patients developed IVC thrombosis and one of them died because of development of bilateral phelgmasia cerulea dolens leading to ischemic foot. Another 8 patients developed lower extremities DVT and therefore the filter was left in place. Among patients with a successful removal, the median dwelling time was 30 days, with a minimum of 8 days and a maximum of 207 days. As seen in the table, no relationship was found between age, sex, BMI, or GCS to successful filter removal.

Table 1.
 Successful Unsuccessful  
Mean age 35.3 (sd = 12.8) 38.1 (sd = 12.7) p = 0.20 
Sex 81% Male 80% Male p = 0.93 
BMI 25.3(sd = 4.7)kg/m2 26.9(sd = 7.3) kg/m2 p = 0.17 
GCS 7.4(sd = 6.1) 7.8(sd = 5.8) p = 0.70 
 Successful Unsuccessful  
Mean age 35.3 (sd = 12.8) 38.1 (sd = 12.7) p = 0.20 
Sex 81% Male 80% Male p = 0.93 
BMI 25.3(sd = 4.7)kg/m2 26.9(sd = 7.3) kg/m2 p = 0.17 
GCS 7.4(sd = 6.1) 7.8(sd = 5.8) p = 0.70 

Of concern are the persistent complications related to the filter such as IVC thrombosis even with the prophylactic use of anticoagulants. Further, the long-term effects of radiation needed for insertion and extraction of the filter are worrisome, especially when it involves young patients. Thus the routine use of IVC filter in trauma patients may not be desirable. Careful assessment of the risks and the benefits is needed especially for young patients.

Disclosures

No relevant conflicts of interest to declare.

Author notes

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Asterisk with author names denotes non-ASH members.