Retrievable inferior vena cava filter for primary prophylaxis of pulmonary embolism in at-risk trauma patients: A feasibility trial. Issue 5 (May 2021) - Curtis, R. Mason
Highlights: The role for retrievable inferior vena cava filter use for PE prevention in high risk trauma patients remains unanswered. Retrievable inferior vena cava filter use for PE prevention is feasible to study, showing a 53 h difference in time left unprotected. No complications of retrievable inferior vena cava filters were encountered, and we had 100% retrieval rate in patients who survived. Further prospective investigation of retrievable inferior vena cava filter use powered for pulmonary embolism reduction is required. Abstract: Objective: To determine if insertion of rIVCF for PE prophylaxis in high risk trauma patients could result in a clinically meaningful reduction (>24 h) in time that patients are left unprotected from PEs Summary and background data: Trauma patients are at high risk for the development of pulmonary embolism (PE). Early pharmacologic PE prophylaxis is ideal, however many patients are unable to receive prophylaxis due to concomitant injuries. Current guidelines are conflicting on the role of prophylactic retrievable inferior vena cava filters (rIVCF) for PE prevention in this patient population, and robust data to guide clinicians is lacking. Methods: In this single center, randomized control trial of adult (age > 18 years) trauma patients at high risk for PE by EAST criteria and unable to receive pharmacologic prophylaxis for at least 72 h, we randomized 42 patients to receive a rIVCF or to not have a rIVCF placed. Our primary endpoints were time left unprotected to PE development and feasibility. Results: The median patient age was 53 years, with a median Injury Severity Score of 33. Randomization to rIVCF reduced the time left unprotected to PE (Control: 78.2 h [53.6–104]; rIVCF: 25.5 h [9.8–44.6], p = 0.0001). Two pulmonary embolisms occurred in the control group, and one in the rIVCF group. Seven deaths occurred in the control group, and 8 in the rIVCF group. Conclusion: This feasibility study demonstrates a clinically meaningful reduction in time left unprotected to PE. Further investigations powered to demonstrate a reduction in PE incidence are required. Level of evidence: Level 1 Evidence randomized controlled trial