Prophylactic IVCFs should be inserted within 48 hours of injury in specific trauma patients at high risk for PE and with contraindications to anticoagulation.
INFERIOR VENA cava filters (IVCFs) are being used with increasing frequency in trauma patients because of the heightened risk of deep vein thrombosis (DVT) and threat of subsequent pulmonary embolism (PE). The incidence of DVT in trauma patients may be as high as 20% to 58%, and the true incidence of PE is unknown. Unfortunately, some investigators have found that routine thromboembolism prophylaxis with sequential compression devices (SCDs), and low-dose heparin sodium is relatively ineffective in high-risk trauma patients. Additionally, many patients are not candidates for anticoagulation because of their associated traumatic injuries, and SCDs may be difficult to place on patients with major long-bone fractures.
Clinical signs of DVT are generally absent, and fatal PE frequently occurs without prior warning, with only a third of fatal PE cases diagnosed before death. Thus, insertion of IVCFs in high-risk trauma patients prior to DVT and/or PE should be able to reduce the incidence of lethal PE. The development of safe and effective, percutaneously placed IVCFs has stimulated an increase in the use of prophylactic IVCFs in high-risk trauma patients in an effort to reduce the incidence of PE.Some institutions have noted a decreased incidence of PE in trauma patients with prophylactic IVCFs.Others, however, have demonstrated conflicting results, noting no difference or an actual increase in the incidence of PE with prophylactic IVCFs.
