Prophylactic Vena Caval Interruption in Hip Fractures

The Increasing Use of Vena Cava Filters in Adult Trauma Victims: Data From the American College of Surgeons National Trauma Data Bank

“…6,12-15 A single randomized prospective study in elderly trauma patients demonstrated that prophylactic partial caval interrup- The Journal of TRAUMA Injury, Infection, and Critical Care tion with an umbrella reduced the incidence of symptomatic and fatal PE. 32 Although some work has implied that prophylactic VCFs are associated with a decrease in the incidence of fatal pulmonary emboli, 12 there has been no comparison of survival between the treatment group and concurrent controls. We found that VCFs were inserted in approximately 1% of patients reported to the NTDB and that the rate of insertion has been increasing during the past 10 years, from 0.3% in 1994 to 1.2% in 2002.…”

Interventional treatment of venous thromboembolism: A review

“…Only two randomized clinical trials have evaluated the efficacy and safety of permanent IVC filters for the prevention of PE [8,9]. Decousus and colleagues randomly assigned 400 patients with proximal DVT and at risk for PE to receive a vena caval filter (200 patients) or not (200 patients), in addition to standard anticoagulant therapy (LMWH, UFH, VKA) [8].…”

“…Fullen at al enrolled in a quasi-randomised trial patients with traumatic hip fracture to receive or not a Mobin-Uddin caval filter; none of the patients received anticoagulant treatment [9]. The rate of PE was 4/41 in the filter group and 19/59 in the control group (RR 0.3, 95% CI 011 to 0.82), showing a statistically significant reduction in the treated group; mortality was similar for filter and not-filter patients (4/41 and 14/59, respectively; RR 0.41, 95% CI 0.15 to 1.16).…”

“…Very recently, a Cochrane review evaluated all existing published controlled clinical trials and randomised clinical trials that examined the efficacy of filters in preventing PE [11]. Only the two above mentioned studies involving a total of 529 people were included [8,9] and the authors concluded that no recommendations can be drawn. On the one hand, one study showed a reduction in PE rates, but not in mortality, and it was subject to significant biases [9].…”

99. Indikation zur Cavafilter-Implantation

“…Fullen [7], der einen R/ickgang der Embolierate nach Hfiftoperationen von 7 auf 1 durch Filterimplantation sah, priifte gegen eine Kontrollgruppe ohne medikament6se Prophylaxe. Beide erm6glichen fiber die Embolieprophylaxe hinaus aber noch die Wiederherstellung eines freien ven6sen Abflusses und verhindern oft ein schweres postthrombotisches Syndrom, sind also der Filter-Implantation wo immer m6glich vorzuziehen!…”