Inferior Vena Cava Filter Use and Risk of DVT/PE Post Arthroplasty

Abstract

Background: Despite anticoagulation use, total joint arthroplasty has a 0.16-1.51% pulmonary embolism (PE) rate and a 0.1-0.2% fatal PE rate. The purpose of this study was to describe the post-operative thrombotic events and complications in patients at high-risk in two groups, those who had an IVC filter placed prior to total joint replacement surgery and those who did not.Methods: Patients from a single surgeon's practice were reviewed between January 1, 2012 to December 31, 2015 that were identified as high-risk for post-operative thrombotic events. Patient demographics, medical history, Charlson Comorbidity Index, filter-related complications, as well as post-operative deep vein thrombosis, pulmonary embolism, bleeding events and hospitalizations were collected retrospectively from the electronic medical records.Results: Fifty-five patients were identified, thirty-six of whom had a filter placed. Two of these had filter placement and removal on separate occasions for separate arthroplasty surgeries. Of the IVC filters placed, two insertional complications were identified. No filter retrieval complications occurred in the filters that were removed. There were nineteen patients deemed high risk for postoperative thrombotic events that did not undergo filter placement. Of these, there were no cases of pulmonary embolism. One patient was found to have a chronic lower-extremity DVT on post-operative work-up. Conclusion:In our series, there were two complications related to filter placement. The group of nineteen high risk patients without a filter placed showed no cases of symptomatic PE. Further multicenter study is required to make definitive recommendations on the use of IVC filters in select arthroplasty patients.

The use of pre-operative Inferior Vena Cava filters for thromboprophylaxis in ultra-high-risk patients undergoing total hip and knee arthroplasty: a systematic review and narrative analysis

“…Ten studies, published between 1988 and 2021, met the inclusion criteria [26,[38][39][40][41][42][43][44][45][46]. There were three prospective studies [41][42][43] and seven retrospective [26,[38][39][40][44][45][46], two of which had a second high-risk group for comparison [26,38].…”

“…Ten studies, published between 1988 and 2021, met the inclusion criteria [26,[38][39][40][41][42][43][44][45][46]. There were three prospective studies [41][42][43] and seven retrospective [26,[38][39][40][44][45][46], two of which had a second high-risk group for comparison [26,38]. The eight studies without a comparison group had a mean MINORS score of 8.5 (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) and the two with a comparator had a mean score of 13.5 (12-15, Table 1).…”

“…All studies included a history of VTE as a high-risk factor. Eight documented such a history in 59% to 100% of cases [26,[38][39][40][41][44][45][46] and three specified a history of PE in 61% to 71% of cases [26,41,46]. The average patient age was 64.7 years (17-95) and 56% were female.…”

“…The average patient age was 64.7 years (17-95) and 56% were female. Seven studies documented the duration of follow-up [26,39,40,[42][43][44]46], ranging from three to 44 months (Table 2).…”

“…For TKA, rates of 1.5% have been calculated for Germany [25], 25.1% for Australia [24] and 5.3-29.3% for the USA [22,23]. Based on an incidence of fatal PE of 0.1% to 0.5% [9,10,26] and an estimated population undergoing TJA in the USA of 2-4 million by 2030, this represents 4,000 to 20,000 potentially avoidable deaths every year in America alone.…”