Abstract
Objectives: Patients sustaining severe trauma are at
high risk for the development of venous thromboembolic
events (VTE). Pharmacologic VTE prophylaxis may
be contraindicated early after trauma due to potential
bleeding complications. The purpose of this study was
to evaluate safety and feasibility of early prophylactic
vena cava filter (VCF) placement and subsequent retrieval
in multiple injured patients with traumatic
brain injury (TBI).
Methods: Analysis of single-institution case series of
consecutive patients who received a prophylactic VCF
after severe TBI (Abbreviated Injury Scale, AiS ‡ 3)
between August 2003 and October 2006.
Results: A total of 34 optional VCF were prophylactically
placed with a median delay of 1 day after trauma
(range, 0–7 days). All patients had sustained multiple
injuries (median Injury Severity Score 41, range, 18–59)
with severe TBI (median AiS 4, range 3–5). Median age
was 41 years (range, 17–67 years). Two patients had
succumbed before potential filter retrieval. Of the
remaining patients, 27 (84%) had their filters
uneventfully retrieved between 11 and 32 days (median,
18 days) after placement with no retrieval-related
morbidity. Five VCF (16%) were left permanently. In
one patient (3%) early inferior vena cava occlusion and
deep venous thrombosis occurred 14 days after VCF
placement. Symptomatic pulmonary embolism was
observed in one patient (3%) 5 days after VCF retrieval.
Overall trauma-related mortality was 9%.
Conclusions: Early VCF placement may be of benefit
for multiple injured patients with TBI when pharmacologic
VTE prophylaxis is contraindicated. VCF
retrieval is safe and feasible. Filter placement- and
retrieval-related morbidity is low.
Meier, C