Retrievable Vena Cava Filters for Preventing Pulmonary Embolism in Trauma Patients: A Cautionary Tale

Abstract

The advent of RFs was associated with a threefold increase in vena cava filter placement in our trauma center. Major FRCs were encountered and a very low incidence of PE was not altered by their use. Successful removal could be verified in only 21% of RFs. The results of this study lead us to question the rationale for a more liberal use of vena cava filters in trauma patients.

Prevention of Venous Thromboembolism in Individuals with Spinal Cord Injury: Clinical Practice Guidelines for Health Care Providers, 3rd ed.

“…The rate of IVC filter insertion in trauma patients has increased exponentially, in large part related to the greater use of retrievable filters (Antevil, 2006;Shackford, 2007;Cherry, 2008;Spate, 2008;Yunus, 2008;Knudson, 2011). However, there is wide variation in IVC filter insertion rates across trauma centers, which cannot be accounted for by patient VTE risk.…”

“…In fact, there are no randomized trials of IVC filter use as primary thromboprophylaxis in any patient group. Numerous studies and a meta-analysis of prospective studies report no difference in the rates of PE among trauma patients with and without a prophylactic IVC filter (Velmahos, 2000:140;Girard, 2003;Antevil, 2006;Shackford, 2007;Cherry, 2008;Knudson, 2011;Kidane, 2012). Another meta-analysis reported a reduction in PE (but not in mortality) in trauma patients with use of prophylactic IVC filters; the number needed to treat to prevent one nonfatal PE with IVC filters was between 109 and 962 .…”

“…The use of prophylactic IVC filters in trauma patients has not been shown to reduce overall mortality or PE-related mortality (Wojcik, 2000;Antevil, 2006;Cherry, 2008;Singh, 2013;. A systematic review of prospective studies found no difference in the rates of PE among trauma patients with and without prophylactic IVC filters (Velmahos, 2000:140).…”

Retrievable vena cava filters: A clinical review

“…Failure to retrieve filters has become a major issue as these devices grow in popularity. 28,29 In this situation, the benefit of using retrievable filters could be mitigated by the same long-term complications associated with permanent filters. Therefore, well-coordinated patient follow-up is essential to ensure optimal use of retrievable filters.…”

“…Only a few studies have investigated the differences in the rate of PE between permanent and retrievable filters and have shown no differences. 29 The long-term complication rates of retrievable filters and how they may differ from permanent filters warrants further investigation. Some studies have also noted the development of PE after filter retrieval.…”