Venous thromboembolism (VTE) is common following major trauma. While delay in thromboprophylaxis initiation by more than 1 to 3 days is associated with a significantly increased risk of VTE and mortality, prophylaxis is also associated with an increased risk of progressive hematoma enlargement in the setting of traumatic brain injury. Retrievable inferior vena cava (IVC) filters have been introduced to address this issue as a primary means of pulmonary embolism (PE) prophylaxis, though there is a lack of high-quality evidence to support their use in this setting. In this multi-centered randomized controlled trial, 240 severely injured patients were randomized to retrievable IVC filter insertion or no filter within 72 hours after admission for trauma, where prophylactic anticoagulation is contraindicated, to determine whether this intervention results in decreased incidence of PE. Researchers found that early IVC filter placement did not result in a significantly lower incidence of symptomatic PE or mortality (13.9% in IVC filter group vs. 14.4% in control group; HR 0.99, 95% CI 0.51 to 1.94, p=0.98). Of 46 and 34 patients in the IVC filter and control groups, respectively, not receiving prophylactic anticoagulation within 7 days post-injury, PE developed in 0% of the IVC filter arm and 14.7% of the control arm (RR 0.00, 95% CI 0.00 to 0.55). Entrapped filter-associated thrombus was found in 6 patients. This study therefore shows that early IVC filter placement for PE prophylaxis was not associated with a lower incidence of symptomatic PE or all-cause mortality at 90 days in patients admitted for major traumatic injury.
Click to read the study in NEJM
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