PROPHYLACTIC VENA-CAVA FILTER INSERTION IN PATIENTS WITH TRAUMATIC SPINAL-CORD INJURY - PRELIMINARY-RESULTS

PULMONARY EMBOLISM (PE) IS a devastating complication in patients with traumatic spinal cord injury (SCI). Prophylactic measures such as ven ous compression hose or low-dose heparin are only partially protective in reducing the risk of venous thromboembolism and are contraindicate d in some patients. Because of extended perturbations in fibrinolytic activity, catecholamine effects on platelet aggregation, increased act ivity of complement and acute phase reactants, abnormally high factor VIII concentrations, and persistent venous stasis with ongoing endothe lial damage, the patient with an SCI remains at prolonged risk for ven ous thromboembolism. A retrospective 5-year review at the Medical Cent er Hospital of Vermont revealed seven patients with eight documented P Es (three fatal; 2.7%) in 111 SCI patients (6.3%). Six PEs (75%) occur red after discharge from the acute care facility. Median time to PE af ter injury was 78 days (range, 9-5993). Although comprising only 4% of all trauma admissions, SCI accounted for 31% of all PEs in the total trauma population (2525 patients). Beginning in July 1991, a new proph ylaxis protocol was instituted, which included the percutaneous insert ion of vena cava filters under local anesthesia in all SCI patients wi th paraplegia or quadriplegia. Fifteen patients have undergone the ins ertion of titanium filters. Impedance plethysmography was performed we ekly to detect deep venous thrombosis. No complications were associate d with vena cava filter insertion. No patients developed deep venous t hrombosis during their acute hospitalization (median, 22 d), and no pa tients have developed PE after filter insertion. A follow-up deep abdo minal Duplex scan of the vena cava was performed, with a 30-day patenc y of 100% and 1-year patency of 81.8%, by the use of life table analys is. The lower patency rate at 1-year follow-up is felt to represent th e trapping of thrombus. We conclude that prophylactic vena cava filter s are safe and effective in patients with traumatic SCI.