Trauma patients with prophylactic IVC filter and chemical prophylaxis: a descriptive study

Introduction

Trauma patients at high risk of thrombosis and bleeding often have a retrievable inferior vena cava filter (IVCF) inserted prophylactically shortly after admission for the prevention of pulmonary embolism. Despite their increasing use in trauma, controversy exists regarding patient selection, benefits and safety. In addition, chemical prophylaxis should be initiated as soon as determined to be safe to do so. Limited data exist describing the use of chemical prophylaxis and the timing of it in relation to IVCF placement in this patient population. We aim to describe such use and timing in relation to IVCF placement.

Methods

All trauma patients with a retrievable prophylactic IVCF inserted over 3.5 years with an age ≥18 and an ISS ≥15 were enrolled into the descriptive study. Patients were identified using the local trauma registry and data collected from the registry and patient chart.

Results

One hundred and three patients with a prophylactic IVCF are described. Mean age was 42.8 ± 17.9 years, 68% were male and they had a mean ISS of 38.6 ± 12. A total of 36.9% had ≥3 injuries. A total of 60.2% had an injury with maximum AIS score ≥5 and the type of injury associated with maximal AIS was head (53.4%), pelvic (19.4%), thoracic (15.5%) and spinal cord injury (11.7%). Shock was present on admission in 8.7% patients, 98.1% required ICU admission, 88.4% required intubation and 27.2% patients required ≥4 PRBC over the first 24 hours. The retrievable IVCF was inserted prophylactically after a mean of 1.7 ± 1.9 days (range 0 to 9 days) of hospital admission. Chemical prophylaxis was initiated 5.7 ± 5.1 days after IVCF in 77.7% patients, and dalteparin or enoxaparin were the initial agents of choice in 93.8% while heparin was chosen in 6.2% of cases. The time from hospital admission to the start of chemical prophylaxis ranged from 6.3 to 8.5 days.

Conclusions

Chemical prophylaxis was initiated in the majority of trauma patients with an IVCF, albeit 22% still did not receive any. When administered, a low-molecular-weight heparin was selected. Although rapidly inserted after admission, there was considerable delay between insertion of IVCF and initiation of chemical prophylaxis. The reasons for this delay require further investigation.