Indications, Complications, and Management of Inferior Vena Cava Filters: The Experience in 952 Patients at an Academic Hospital With a Level I Trauma Center.
ABSTRACT IMPORTANCE Retrievable inferior vena cava (IVC) filters were designed to provide temporary protection from pulmonary embolism, sparing patients from long-term complications of permanent filters. However, many retrievable IVC filters are left in place indefinitely. OBJECTIVES To review the medical records of patients with IVC filters to determine patient demographics and date of and indication for IVC filter placement, as well as complications, follow-up data, date of IVC filter retrieval, and use of anticoagulant therapy. DESIGN AND SETTING A retrospective review of IVC filter use between August 1, 2003, and February 28, 2011, was conducted at Boston Medical Center, a tertiary referral center with the largest trauma center in New England. PARTICIPANTS In total, 978 patients. Twenty six patients were excluded from the study because of incomplete medical records. INTERVENTION Placement of retrievable IVC filter. MAIN OUTCOME MEASURES In total, 952 medical records were included in the analysis. RESULTS Of 679 retrievable IVC filters that were placed, 58 (8.5%) were successfully removed. Unsuccessful retrieval attempts were made in 13 patients (18.3% of attempts). Seventy-four venous thrombotic events (7.8% of 952 patients included in the study) occurred after IVC filter placement, including 25 pulmonary emboli, all of which occurred with the IVC filter in place. Forty-eight percent of venous thrombotic events were in patients without venous thromboembolism at the time of IVC filter placement, and 89.4% occurred in patients not receiving anticoagulants. Many IVC filters placed after trauma were inserted when the highest bleeding risk had subsided, and anticoagulant therapy may have been appropriate. While many of these filters were placed because of a perceived contraindication to anticoagulants, 237 patients (24.9%) were discharged on a regimen of anticoagulant therapy. CONCLUSION AND RELEVANCE Our research suggests that the use of IVC filters for prophylaxis and treatment of venous thrombotic events, combined with a low retrieval rate and inconsistent use of anticoagulant therapy, results in suboptimal outcomes due to high rates of venous thromboembolism.
- JAMA Internal Medicine 03/2013; 173(7):1-3. DOI:10.1001/jamainternmed.2013.2725 · 13.25 Impact Factor
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ABSTRACT: The management of thromboprophylaxis in patients with pelvic and acetabular fractures remains a highly controversial topic within the trauma community. Despite anticoagulation, venous thromboembolism (VTE) remains the most common cause of surgical morbidity and mortality in this high-risk patient group. Although various thromboprophylactic regimes are employed, evidence relating to the most effective method remains unclear. Controversies surrounding screening, the use of prophylactic inferior vena cava filters (IVCF) and chemothromboprophylaxis in polytraumatised patients, particularly those with pelvic and acetabular fractures, form the basis of considerable debate. With the absence of a well-designed clinical trial and the presence of ongoing controversies within the literature, this review will explore current treatment options available to trauma surgeons and highlight differing scientific opinions, providing an update on the role of screening and current available preventative measures. We cover existing as well as recent advances in chemical thromboprophylactic agents and discuss external mechanical compression devices, the usefulness of serial duplex ultrasonography and the role of extended chemothromboprophylaxis on discharge. The evidence behind prophylactic IVCF is also considered, along with reported complication profiles. We conclude with a proposed protocol for use in major trauma centres, which can form the basis of local policy for the prevention of VTE in trauma patients with pelvic and acetabular fractures.Injury 06/2013; 44(12). DOI:10.1016/j.injury.2013.04.030 · 2.46 Impact Factor
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ABSTRACT: Cases of pulmonary embolism (PE) with contraindication of anticoagulation have low incidence. Under these circumstances the placement of an inferior vena cava (IVC) filter may be life-saving. Paradoxically, the presence of the filter imposes anticoagulation itself, due to the risk of filter thrombosis, promoting stasis and increasing the risk of filter related deep venous thrombosis (DVT) and PE recurrence by means of a substantial collateral venous return that bypasses the IVC filter (1,2). We present the case of a woman with DVT, complicated with high risk PE. After thrombolysis with alteplase the patient develops retroperitoneal hematoma originating from undiagnosed renal angiomyolipoma. Therefore long term anticoagulation is considered contraindicated and an IVC filter is installed. Shortly after hospital release the patient presents occlusion of the IVC filter with DVT recurrence. The initiation of low molecular weight heparin and afterwards of acenocumarol has a favorable outcome, and after six months of follow up the patient is completely recovered.09/2013; 8(4):355-359.