EFFICACY OF PROPHYLACTIC VENA-CAVA FILTERS IN HIGH-RISK TRAUMA PATIENTS

Severely injured trauma patients are at increased risk of pulmonary em bolism (PE). Certain injuries may preclude the use of standard prophyl actic measures, and even when used, these measures may be ineffective in the trauma population. We defined a group of trauma patients who ar e at statistically elevated risk of venous thromboembolic events. We t hen adopted an aggressive approach to the placement of prophylactic in ferior vena cava (IVC) filters in these high-risk patients. Between Ja nuary 1994 and January 1996 we treated 250 trauma patients who met our high-risk criteria. Prophylactic IVC filters were placed in 99 of the se patients, and 151 received deep venous thrombosis prophylaxis with either heparin, sequential compression stockings, or a combination of these modalities. High-risk patients did not receive filters if they w ere unlikely to survive or showed rapid clinical improvement and were felt to not remain at high risk. The incidence of pulmonary embolism i n this high-risk population was 1.6%. This is a significant reduction (p = 0.045, Fisher exact test) from the 4.8% incidence of PE in high-r isk historical control patients with similar injury profiles. No patie nt with a prophylactic IVC filter suffered a clinically evident PE and there were no complications associated with placement of these filter s. We conclude that the placement of prophylactic IVC filters in high- risk trauma patients is a safe and effective method of reducing the in cidence of pulmonary embolism.