Orly Lavan1, Uri Rimon2, Dani Simon3, Boris Khaitovich2, Batia Segal3, Ehud Grossman1, Yeroham Kleinbaum2, David M Steinberg4, Ophira Salomon5. 1. Department of Internal Medicine D and Sackler Faculty of Medicine Tel Aviv University, Israel. 2. Diagnostic Imaging Sheba Medical Center and Sackler Faculty of Medicine Tel Aviv University, Israel. 3. Trauma unit Sheba Medical Center, Israel. 4. Department of Statistics and Operations Research, Faculty of Exact Sciences, Tel Aviv University, Israel. 5. Thrombosis and Hemostasis Unit and Sheba Medical Center and Sackler Faculty of Medicine Tel Aviv University, Tel Aviv, Israel. Electronic address: ophiras@sheba.health.gov.il.
Abstract
BACKGROUND: Venous thromboembolism (VTE) is a frequent complication of patients who experienced major trauma. Prevention of VTE is usually by thrombophylaxis and or by the use of a retrievable filter. Lately, the use of a retrievable filter in trauma patients has increased despite evidence cautioning against its use. AIMS: To evaluate complications related to a single type of filter prophylactically used in a tertiary trauma center and search for risk factors that may preclude filter retrieval METHODS: 142 patients aged 16 through 60 who experienced a major trauma and were treated with a prophylactic IVC filter of type optease were evaluated. RESULTS: The median time from trauma to filter insertion was 2days and low molecular weight heparin at prophylactic dose was initiated in 92% once the filter was inserted. Nine patients developed IVC thrombosis and one of them died despite the use of thrombolytic therapy. Another 8 patients developed lower extremities deep vein thrombosis. The filter was left in place in 13 more patients after attempted filter removal was unsuccessful. Among patients with successful removal, the median dwelling time was 30days. There was no relationship between successful removal and age, sex, BMI, Glasgow coma scale, or injury severity score of patients when first evaluated. CONCLUSIONS: Of concern is the persistent complications related to IVC filter even with the prophylactic use of anticoagulants and the dose of radiation trauma patients were exposed during insertion and retrieval of filter. Thus, the routine use of IVC filter in trauma patients may not be desirable.
BACKGROUND:Venous thromboembolism (VTE) is a frequent complication of patients who experienced major trauma. Prevention of VTE is usually by thrombophylaxis and or by the use of a retrievable filter. Lately, the use of a retrievable filter in traumapatients has increased despite evidence cautioning against its use. AIMS: To evaluate complications related to a single type of filter prophylactically used in a tertiary trauma center and search for risk factors that may preclude filter retrieval METHODS: 142 patients aged 16 through 60 who experienced a major trauma and were treated with a prophylactic IVC filter of type optease were evaluated. RESULTS: The median time from trauma to filter insertion was 2days and low molecular weight heparin at prophylactic dose was initiated in 92% once the filter was inserted. Nine patients developed IVC thrombosis and one of them died despite the use of thrombolytic therapy. Another 8 patients developed lower extremities deep vein thrombosis. The filter was left in place in 13 more patients after attempted filter removal was unsuccessful. Among patients with successful removal, the median dwelling time was 30days. There was no relationship between successful removal and age, sex, BMI, Glasgow coma scale, or injury severity score of patients when first evaluated. CONCLUSIONS: Of concern is the persistent complications related to IVC filter even with the prophylactic use of anticoagulants and the dose of radiation traumapatients were exposed during insertion and retrieval of filter. Thus, the routine use of IVC filter in traumapatients may not be desirable.