Prophylactic retrievable inferior vena cava filters in spinal cord injured patients

Abstract

Background:Pulmonary embolus (PE) secondary to deep vein thrombosis (DVT) continues to be a major source of morbidity and mortality in trauma populations. Patients with cervical spinal cord injury (SCI) are particularly susceptible to developing this complication. Non-invasive methods of preventing SCI, such as lower extremity compression devices and anticoagulation, do not confer complete protection against DVT. Retrievable inferior vena cava filters (IVCFs) offer the advantage of both providing protection against PE and avoidance of long-term complications such as DVT, if removed in a timely fashion. Our goals in this study were to identify complications related to IVCF insertion and also to determine if prophylactic insertion of IVCF is effective in preventing PE in spinal cord injured patients.Methods:This was a retrospective single center study that involved cervical SCI patients who were admitted to Parkview Hospital, a level II trauma center, from January 2003 to December 2009 and underwent placement of a prophylactic IVCF within 72 hours of admission. Patients were identified from a prospectively maintained trauma registry.Results:During a 6-year period, 45 spinal cord injured patients were identified, who underwent placement of a prophylactic IVCF. There were 37 men and 8 women. There were no short-term complications associated with peripheral intravenous catheter (PIVC) insertion. Seventeen of the 45 (37%) patients underwent successful removal of the filter within 6–8 weeks of insertion. Twenty patients did not return for removal during the 6–8 week period for removal and eight patients were lost to follow-up. None of the patients who underwent prophylactic IVCF placement sustained a PE.Conclusion:Our results suggest that the use of retrievable prophylactic IVCF is a safe procedure and has the added benefit of preventing the long-term lower extremity thrombotic complications associated with their use. Even though none of the patients sustained a PE, definitive conclusions regarding the efficacy of IVCF in preventing PE could not be made due to the small sample size of our study.