Objective

Patients with multiple trauma often have injuries that preclude the use of anticoagulation for venous thromboembolism (VTE) prophylaxis. Temporary inferior vena cava (IVC) filters offer protection against pulmonary embolism (PE) during the early immediate injury and perioperative period, when risk is highest, while averting potential long term sequelae of permanent IVC filters. The purpose of this study was to document the initial experience, indications, clinical success, and complications with a specific prophylactic retrievable IVC filter at a level II trauma center.

Hypothesis

Prophylactic retrievable IVC filters are safe and effective in trauma patients who are at high risk for VTE and have a provisional contraindication(s) to anticoagulant therapy and/or barriers to placement of sequential compression devices (SCD’s).

Design

Retrospective Review

Setting

Urban level II trauma center.

Subjects

Multiple trauma patients undergoing VTE prophylaxis. All patients were at high risk for VTE but had provisional contraindication(s) to prophylactic anticoagulation therapy with low molecular weight heparin (LMWH) and /or barriers to placement of SCD’s.

Interventions

The interventional radiologist placed the Recovery Filter (RF) in all selected patients. The filter was removed when the patient could safely be prophylaxed with LMWH and/or the risk of VTE had diminished due to resumption of full physical activity.

Main Outcome Measures

Complications of filter insertion and removal, venous thrombosis, pulmonary embolism, and length of stay of the filter.

Results

From July 1, 2004 to February 1, 2005, nine (n=9) patients underwent placement of RF temporary IVC filters. Male to female ratio was 8:1. Ages ranged from (18-50) with a mean of (31). Indications for placement were recent pulmonary embolism (n=1), and thromboembolism prophylaxis (n=8). All nine patients had a provisional contraindication(s) to prophylactic and/or therapeutic anticoagulation therapy with LMWH, and /or barriers to placement of SCD’S. The mean Injury Severity Score was (24). Mechanism of injury in all cases was blunt. There were no complications associated with filter insertion or removal. There were no documented instances of VTE following IVC filter placement and removal. The contraindication(s) for anticoagulant therapy with LMWH were the following: traumatic brain injury, non-operative solid organ injury, pelvic fractures and spinal fractures with associated neurologic deficits. The contraindications for SCD’s were usually long bone fractures that required immobilization with traction or ex-fitter devices. The mean duration between placement and removal was (33) days (range 10 - 69 days). Four filters were left in as permanent filters due to the ongoing risk of DVT/PE. In all cases, no trapped thrombus was seen within the filter upon removal.

Conclusions

Although this experience is small, retrospective, and deficient in long-term follow up, prophylactic retrievable IVC filters are safe and effective in trauma patients who are at high risk for venous thromboembolism and have a provisional contraindication(s) to anticoagulant therapy. Prophylactic retrievable IVC filters are particularly beneficial in younger trauma patients who are more likely to experience possible long-term complications from permanent IVC filters. We have also demonstrated the feasibility and safety of retrieval of up to (69) days after implantation of the new Recovery Filter. The RF does not require of any intervening repositioning procedure as compared to other temporary IVC filters. The RF can also be left in place as a permanent filter if needed.  In patients with multiple trauma, prophylactic retrievable IVC filters serve as an effective “bridge” to anticoagulation therapy for venous thromboembolism prophylaxis.