Vena cava filters in spinal cord injuries: evolving technology.
BACKGROUND
Asymptomatic deep venous thrombosis (DVT) has been reported in 60% to 100% of persons with spinal cord injury (SCI). Several guidelines have been published detailing recommended venous thromboembolism (VTE) prophylaxis after acute SCI. Low-molecular-weight heparin, intermittent pneumatic compression (IPC) devices, and/or graduated compression stockings are recommended. Vena cava filters (VCFs) are recommended for secondary prophylaxis in certain situations.


OBJECTIVE
To clarify the use of vena cava filters in patients with SCI.


METHODS
Literature review.


RESULTS
Prophylactic use of vena cava filters has expanded in trauma patients, including individuals with SCI. Filter placement effectively prevents pulmonary emboli and has a low complication rate. Indications include pulmonary embolus while on anticoagulant therapy, presence of pulmonary embolus and contraindication for anticoagulation, and documented free-floating ileofemoral thrombus. VCFs should be considered in patients with complete motor paralysis caused by lesions in the high cervical cord (C2 and C3), with poor cardiopulmonary reserve, or with thrombus in the inferior vena cava despite anticoagulant prophylaxis. Three optional retrievable filters that are approved for use are discussed.


CONCLUSIONS
Retrievable VCFs are a safe, feasible option for secondary prophylaxis of VTE in patients with SCI. Objective criteria for temporary and permanent placement need to be defined.
Johns
Jeffery S
JS
Department of Physical Medicine and Rehabilitation, Charlotte Institute of Rehabilitation, Charlotte, North Carolina, USA. Jeff.Johns@carolinashealthcare.org
Nguyen
Conner
C
Sing
Ronald F
RF
D000925:Anticoagulants / Q000627:therapeutic use; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D011655:Pulmonary Embolism / Q000209:etiology / Q000517:prevention & control; D013119:Spinal Cord Injuries / Q000150:complications; D016306:Vena Cava Filters / Q000009:adverse effects / Q000639:trends*; D014682:Vena Cava, Inferior / Q000601:surgery; D020246:Venous Thrombosis / Q000209:etiology* / Q000517:prevention & control*
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight