EARLY PLACEMENT OF PROPHYLACTIC VENA-CAVAL FILTERS IN INJURED PATIENTS AT HIGH-RISK FOR PULMONARY-EMBOLISM

Objective: Pulmonary embolism (PE) is a major problem in patients with multiple injuries, We present our experience with early placement of prophylactic vena caval filters (VCFs). Design: Prospective study grou p with historical control. Materials and Methods: From March 1993 to D ecember 1993, VCFs were placed in 40 consecutive patients with three o r more risk factors for PE and had demographic, physiologic, venous th romboembolic prophylaxis, and outcome data collected prospectively (VC F group). They were compared to 80 injured patients admitted between N ovember 1991 and February 1993 who survived > 48 hours and who were ma tched with the VCF group for mechanism of injury and risk factors for PE (NO VCF group). Measurements and Main Results: VCF placement affect ed a significant reduction in the incidence of PE (2.5% vs. 17%) and a clinical reduction in PE-related mortality. Embolic trapping was sugg ested by a 10% incidence of documented vena caval thrombi and although two patients developed significant venous stasis disease, no other VC F-related morbidity was noted. Conclusions: In spite of long-term morb idity, early prophylactic VCF placement is safe and should be consider ed in the prophylaxis of PE in the high-risk injured patients. This in tervention may be effective in eliminating PE as a major cause of post trauma morbidity and mortality.