TS03THE EFFICACY AND SAFETY OF PROPHYLACTIC VENA CAVA FILTERS AFTER MAJOR TRAUMA

• Published in: ANZ journal of surgery 2009-05, Vol.79 (s1), p.A85-A85
• Main Authors: Batty, L. M., Dowrick, A. S., Bailey, M., Lyon, S. M., Liew, S. M.
• Format: Article
• Language: English
• Subjects: Blood clots; Clinical outcomes; Coronary vessels; Injuries; Medical equipment; Thoracic surgery; Trauma care
• ISSN: 1445-1433; 1445-2197
• DOI: 10.1111/j.1445-2197.2009.04934_3.x

Despite increasing use of vena cava filters (VCFs) for pulmonary embolism (PE) prophylaxis after trauma, there is continued debate regarding their safety and efficacy. Prospectively collected data from The Alfred Hospital's trauma registry were used to identify all major trauma patients admitted between 1/7/2001 and 1/7/2008. These data were matched to data from the Department of Radiology's VCF Database. 6,344 major trauma patients were treated during this period with 73.2% male, mean age of 44.2 ± 21.0 SD, 90.2% with a blunt mechanism of injury and mean ISS of 24.3 ± 12.0 SD. Of these patients, 511 (8.1%) received prophylactic VCFs (inserted in absence of PE) at the discretion of the treating clinician. There were 45 PE (0.71%), 2 of which were fatal. Three variables were independently associated with the occurrence of PE in a multivariate logistic regression model: presence of prophylactic VCF (OR 0.28; 95%CI 0.09-0.89); number of injuries to the AIS body region lower limb (OR 1.31; 95%CI 1.17-1.47) and central venous catheterization (OR 1.87; 95%CI 1.88-6.17). Data were available on the VCF database for 429 of the 511 patients with VCFs (84.0%). The mean time to prophylactic VCF insertion was 3.6 ± 0.2 SEM days after admission. The VCF major complication rate was 2.6% (n = 11), including 4 non-fatal PE. The technical success rate for retrieval was 92.4% (279 retrievals from 302 attempts) and the overall retrieval rate was 65.0% (279 retrievals from 429 placements). Prophylactic VCFs are associated with a reduced rate of PE when used in selected major trauma patients. In addition, prophylactic VCFs have a low major complication rate and high rate of technical success for retrieval. [PUBLICATION ABSTRACT]