SURGICAL PROPHYLAXIS FOR PULMONARY-EMBOLISM

The trauma patient population is at special risk for fatal pulmonary e mbolism. We experienced 11 fatalities in one 12-month period. Specific risk factors for both deep venous thrombosis and pulmonary embolism c an be identified among trauma patients. The latter usually cannot be o ffered prophylactic anticoagulation, and the nature of their injuries (e.g., long bone fractures) makes not only bedside surveillance diffic ult but also precludes use of pneumatic compression, etc. We have deve loped a protocol for prophylactic inferior vena caval filtration for o ur trauma patients deemed at particular risk for pulmonary embolism. S ince 1986 we have inserted 205 Greenfield filters in 201 patients. Two hundred were inserted prophylactically. There was no mortality, and m orbidity was minimal. No patient with a Greenfield filter sustained a fatal pulmonary embolism during this period. Four patients died from p ulmonary embolism before vena caval filters could be inserted. We beli eve that the trauma patient, at risk for pulmonary embolism, should be offered a Greenfield filter prophylactically as soon after hospitaliz ation as logistically possible.