Early placement of prophylactic vena caval filters in injured patients at high risk for pulmonary embolism

OBJECTIVE: Pulmonary embolism (PE) is a major problem in patients with multiple injuries. We present our experience with early placement of prophylactic vena caval filters (VCFs). DESIGN: Prospective study group with historical control. MATERIALS AND METHODS: From March 1993 to December 1993, VCFs were placed in 40 consecutive patients with three or more risk factors for PE and had demographic, physiologic, venous thromboembolic prophylaxis, and outcome data collected prospectively (VCF group). They were compared to 80 injured patients admitted between November 1991 and February 1993 who survived > 48 hours and who were matched with the VCF group for mechanism of injury and risk factors for PE (NO VCF group). MEASUREMENTS AND MAIN RESULTS: VCF placement affected a significant reduction in the incidence of PE (2.5% vs. 17%) and a clinical reduction in PE-related mortality. Embolic trapping was suggested by a 10% incidence of documented vena caval thrombi and although two patients developed significant venous stasis disease, no other VCF-related morbidity was noted. CONCLUSIONS: In spite of long-term morbidity, early prophylactic VCF placement is safe and should be considered in the prophylaxis of PE in the high-risk injured patients. This intervention may be effective in eliminating PE as a major cause of posttrauma morbidity and mortality.