Prophylactic Inferior Vena Cava Filters for Venous Thromboembolism in Adults With Trauma: An Updated Systematic Review and Meta-Analysis

Abstract

Background: Trauma is an independent risk factor for venous thromboembolism (VTE). Due to contraindications or delay in starting pharmacological prophylaxis among trauma patients with a high risk of bleeding, the inferior vena cava (IVC) filter has been utilized as alternative prevention for pulmonary embolism (PE). Albeit, its clinical efficacy has remained uncertain. Therefore, we performed an updated systematic review and meta-analysis on the effectiveness and safety of prophylactic IVC filters in severely injured patients. Methods: Three databases (MEDLINE, EMBASE, and Cochrane) were searched from August 1, 2012, to October 27, 2021. Independent reviewers performed data extraction and quality assessment. Relative risk (RR) at 95% confidence interval (CI) pooled in a randomized meta-analysis. A parallel clinical practice guideline committee assessed the certainty of evidence using the GRADE approach. The outcomes of interest included VTE, PE, deep venous thrombosis, mortality, and IVC filter complications. Results: We included 10 controlled studies (47 140 patients), of which 3 studies (310 patients) were randomized controlled trials (RCTs) and 7 were observational studies (46 830 patients). IVC filters demonstrated no significant reduction in PE and fatal PE (RR, 0.27; 95% CI, 0.06-1.28 and RR, 0.32; 95% CI, 0.01-7.84, respectively) by pooling RCTs with low certainty. However, it demonstrated a significant reduction in the risk of PE and fatal PE (RR, 0.25; 95% CI, 0.12-0.55 and RR, 0.09; 95% CI, 0.011-0.81, respectively) by pooling observational studies with very low certainty. IVC filter did not improve mortality in both RCTs and observational studies (RR, 1.44; 95% CI, 0.86-2.43 and RR, 0.63; 95% CI, 0.3-1.31, respectively). Conclusion: In trauma patients, moderate risk reduction of PE and fatal PE was demonstrated among observational data but not RCTs. The desirable effect is not robust to outweigh the undesirable effects associated with IVC filter complications. Current evidence suggests against routinely using prophylactic IVC filters.

Saudi Critical Care Society clinical practice guidelines on the prevention of venous thromboembolism in adults with trauma: reviewed for evidence-based integrity and endorsed by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine

“…Nevertheless, the efficacy and safety of this approach in trauma patients remain unclear. The pooled estimate from RCTs demonstrated no significant difference between the prophylactic IVCF group and the control group in mortality (RR 1.44; 95% CI 0.86–2.43; low quality), PE (RR 0.27; 95% CI 0.06–1.28; low quality), and DVT (RR 1.18; 95% CI 0.58–2.40; low quality) [ 97 – 99 ]. Similarly, pooled estimates from observational studies demonstrated no clear association between the use of prophylactic IVCFs and the risks of mortality (RR 0.63; 95% CI, 0.3–1.31; very low quality) or DVT (RR 1.65; 95% CI 0.85–3.2; very low quality) [ 100 – 103 ].…”

Traumatic Brain Injury in Patients under Anticoagulant Therapy: Review of Management in Emergency Department

“…Byrnes et al [112] reported 42 patients with traumatic ICI who subsequently developed thrombotic complications; ICI remained stable in 25 out of 26 patients who started therapeutic anticoagulation 13 days after the injury and bleeding signs slightly increased in only one patient. As an alternative, there are reports suggesting the use of inferior vena cava filter insertion together with pharmacological prophylaxis [113].…”

Optimizing inferior vena cava filter design: A computational fluid dynamics study on strut configuration for enhanced hemodynamic performance and thrombosis reduction

“…Only if this proves impossible or ineffective, due to contraindications or recurring PE, is filter placement recommended [ 3 ]. While some small trials suggest short-term benefits of IVC filters in preventing PE after trauma surgery, conclusive evidence for long-term efficacy remains elusive due to the absence of large-scale randomized controlled trials [ 4 , 5 ]. This shows that IVC filter use can be associated with many complications, including thrombosis.…”