Shenoy Rathna, Cunningham Kyle W, Ross Samuel Wade, Christmas A Britton, Thomas Bradley W, Avery Michael J, Lessne Mark L, Prasad Tanushree, Sing Ronald F
Am Surg. 2019 Aug 1;85(8):806-812.
The role of prophylactic vena cava filters (pVCFs) in trauma patients remains controversial. After 20 years of data collection and experience, we reviewed our venous thromboembolism guideline for the efficacy of pVCFs in preventing pulmonary embolism (PE). A retrospective cohort study was performed using our Level I trauma center registry from January 1997 thru December 2016. This population was then divided by the presence of pVCFs. Univariate analysis was performed comparing the incidence of PEs, deep vein thrombosis, and mortality between those with and without a pVCF. There were 35,658 patients identified, of whom 2 per cent (n = 847) received pVCFs. The PE rate was 0.4 per cent in both groups. The deep vein thrombosis rate for pVCFs was 3.9 per cent compared with 0.6 per cent in the no-VCF group ( < 0.0001). Given that there was no difference in the rates of PEs between the cohorts, the subset of patients with a PE were analyzed by their risk factors. Only ventilator days > 3 were associated with a higher risk in the no-pVCF group (0.2 1.5%, = 0.033). pVCFs did not confer benefit reducing PE rate. In addition, despite their intended purpose, pVCFs cannot eliminate PEs in high-risk trauma patients, suggesting a lack of utility for prophylaxis in this population.
预防性腔静脉滤器（pVCF）在创伤患者中的作用仍存在争议。经过20年的数据收集和经验积累，我们回顾了静脉血栓栓塞指南中关于pVCF预防肺栓塞（PE）的疗效。我们使用1997年1月至2016年12月期间一级创伤中心登记处的数据进行了一项回顾性队列研究。然后根据是否存在pVCF对该人群进行划分。对有或没有pVCF的患者的PE、深静脉血栓形成和死亡率进行单因素分析比较。共识别出35658例患者，其中2%（n = 847）接受了pVCF。两组的PE发生率均为0.4%。接受pVCF的患者深静脉血栓形成率为3.9%，而未接受滤器组为0.6%（<0.0001）。鉴于两组之间的PE发生率没有差异，对发生PE的患者亚组按其危险因素进行分析。仅机械通气天数>3天在未接受pVCF组中与较高风险相关（0.2%对1.5%，P = 0.033）。pVCF并不能降低PE发生率。此外，尽管其预期用途如此，但pVCF并不能消除高危创伤患者的PE，这表明在该人群中预防性使用缺乏实用性。
