Variability of Prophylactic Inferior Vena Cava Filter Use in Young Trauma Patients: Analysis of the Consortium of Leaders in the Study of Traumatic Thromboembolism Database

Abstract

Background: Data suggest prophylactic IVC filters (IVCFs) are associated with a slightly reduced pulmonary embolism rate, increased deep venous thrombosis rates, adverse events, increased cost, and no mortality benefit. We hypothesized that there would be few indications for prophylactic IVCFs in trauma patients, and use would be lower than historically reported.

Study design: The Consortium of Leaders in the Study of Traumatic Thromboembolism is a prospective, observational, cohort, multicenter study conducted at 17 US Level I trauma centers between 2018 and 2020, including patients aged 18 to 40 years, to examine the prevention and management of venous thromboembolism (VTE). We conducted a per-center analysis of placement rates, timing, and indications for prophylactic IVCFs.

Results: Seventy-four of 7,880 trauma patients (0.94%) had prophylactic IVCFs inserted. The majority sustained blunt trauma (mean injury severity score = 30). IVCFs were placed by interventional radiologists (72.4%), vascular surgeons (17.2%), and trauma surgeons (10.3%). The mean time from injury to placement was 7.2 (SD 7.0) days. Rates of IVCFs per center varied widely, with a rate ranging from 2 per 622 patients (0.3%) to 9 per 71 patients (12.7%). Prophylactic IVCF insertion indications were as follows: neurotrauma 24.7%, repeat operations 26.9%, spinal cord injury with paralysis 7.5%, coagulopathy 17.2%, solid organ injury 8.6%, and spine fracture 7.5%. The mean time to initiation of VTE prophylaxis was 4.8 days. Sixty-two percent of patients had VTE prophylaxis initiated before or on the same day as IVCF insertion. All centers had patients who never received pharmacologic VTE prophylaxis (range 2.4% to 30.6%), but this did not correlate with increased prophylactic IVCF insertion.

Conclusions: There is variation in the use of prophylactic IVCFs after major trauma. Our data lend support to recent practice management guidelines and should lead to more consistent care of major trauma patients about prophylactic IVCFs.