title: Prophylactic and therapeutic inferior vena cava filters to prevent pulmonary emboli in trauma patients.
abstract: OBJECTIVE
  Insertion of inferior vena cava filters (IVCFs) can prophylactically reduce pulmonary embolism (PE) in trauma patients.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Urban, level I trauma center.
  
  
  METHODS
  Two hundred blunt trauma patients undergoing IVCF placement.
  
  
  METHODS
  In 122 patients who had already been diagnosed as having deep vein thrombosis (DVT) (112 patients) and/or PE (22 patients), the insertion of the IVCF was considered "therapeutic." In 78 patients who had no evidence of DVT or PE but who were considered to be at high risk for a PE, the IVCF was considered "prophylactic."
  
  
  METHODS
  Incidence of PE and related mortality and morbidity in therapeutic vs prophylactic IVCFs.
  
  
  RESULTS
  The number of prophylactic IVCFs inserted increased significantly from only 4% (3/68 cases) from 1991 through 1996, up to 57% (75/132 cases) from 1997 to June 2001. Although the mean +/- SD age (51 +/- 20 years vs 41 +/- 15 years; P<.001) was higher in the therapeutic group, there was no difference in the mean +/- SD Injury Severity Scores (20 +/- 12 vs 21 +/- 11). Therapeutic filters were placed much later after injury (mean +/- SD time, 11 +/- 7 vs 3 +/- 2 days; P<.001). The mortality rate was 11% (13/122 patients) in patients having a therapeutic IVCF, as compared with only 3% (2/78 patients) in those placed prophylactically (P =.07). None of the patients who had placement of a prophylactic IVCF developed subsequent PE. The incidence of PE decreased in all blunt trauma patients from 0.29% before 1997 to 0.15% after January 1, 1997, when 57% of the IVCF inserted were prophylactic (P =.06).
  
  
  CONCLUSIONS
  Prophylactic IVCFs should be inserted within 48 hours of injury in specific trauma patients at high risk for PE and with contraindications to anticoagulation.
authors: Department of Surgery, Detroit Receiving Hospital, Wayne State University School of Medicine, 3990 John R, Suite 400, Detroit, MI 48201, USA. acarlin@med.wayne.edu
authors: Arthur M
authors: AM
authors: Carlin
authors: James G
authors: JG
authors: Tyburski
authors: Robert F
authors: RF
authors: Wilson
authors: Christopher
authors: C
authors: Steffes
mesh_terms: D000328:Adult; D000925:Anticoagulants; D000075202:Contraindications; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011655:Pulmonary Embolism / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D013997:Time Factors; D016306:Vena Cava Filters; D020246:Venous Thrombosis / Q000628:therapy; D014949:Wounds, Nonpenetrating / Q000150:complications
chemical_list: D000925:Anticoagulants