Prevention of venous thromboembolism after injury: an evidence-based report--part II: analysis of risk factors and evaluation of the role of vena caval filters.
OBJECTIVE
In part II, we describe the results of the literature search and data analysis concerning risk factors for venous thromboembolism and the role of vena caval filters (VCF) in preventing pulmonary embolism.


METHODS
The methodology used in part I was used in part II.


RESULTS
Spinal fractures and spinal-cord injuries increase the risk for development of deep venous thrombosis (DVT) by twofold and threefold, respectively. Patients with DVT were an average of 9 years older than patients without DVT. No specific age cut-off point for increased risk could be established because data could not be combined across studies. Patients with prophylactically inserted VCF had a lower incidence of pulmonary embolism (0.2%) compared with concurrently managed patients without VCF (1.5%) or historical controls without VCF (5.8%). These results are reported on uncontrolled studies with observational design.


CONCLUSIONS
Spinal injuries, spinal cord injuries, and age are risk factors for development of DVT. Prophylactic placement of VCF in selected trauma patients may decrease the incidence of pulmonary embolism. Future research with well-designed studies is required to provide definitive answers.
Department of Surgery, Keck School of Medicine, Los Angeles County, University of Southern California Medical Center, 90033, USA. velmahos@hsc.usc.edu
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Velmahos
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Kern
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Chan
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Oder
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Murray
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Shekelle
D019317:Evidence-Based Medicine; D006801:Humans; D015994:Incidence; D011655:Pulmonary Embolism / Q000453:epidemiology / Q000517:prevention & control; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000453:epidemiology; D016103:Spinal Fractures / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D016306:Vena Cava Filters; D020246:Venous Thrombosis / Q000453:epidemiology* / Q000517:prevention & control*; D014947:Wounds and Injuries / Q000150:complications*