ICU Journal Club- IVC Filters in Severe Trauma

by

Dr Swapnil Pawar & Dr Jose Chacko

A Multi-centre Trial of Vena Cava Filters in Severely Injured Patients

Ho et al. N Engl J Med 2019; 381:328-337
DOI: 10.1056/NEJMoa1806515

Problem –

• 18% of trauma patients develop Proximal DVTs (without anticoagulation)
• 11% of patients develop PE
• 37% of all major PEs occur in first 4 days following trauma
• Fatal PE – less common (0.4-42%)
• 12% of all major trauma patients half of this may be preventable 
• 1-3 days of delay in commencing DVT prophylaxis  3x increased risk of developing DVT 
• Prophylactic anticoagulation – 13x increased risk of haematoma (TBI)
• Data from EPO –TBI – 43% of patients don’t receive DVT prophylaxis for 1^st 7 days 

Hypothesis –

Early placement (<72hrs) of IVC filters in severely injured trauma patients with C/I to prophylactic anticoagulation reduces the risk of symptomatic PE.