Tran Thien Trung, Bjarnason Haraldur, McDonald Jennifer, Goss Brian, Kim Brian, Houghton Damon E, Stavem Knut, Kløw Nils Einar
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway.
Department of Diagnostic Imaging and Intervention, Akershus University Hospital, Lørenskog, Norway.
Eur J Radiol Open. 2020 Dec 10;8:100299. doi: 10.1016/j.ejro.2020.100299. eCollection 2021.
Use of inferior vena cava (IVC) filters in patients following severe trauma without recent history of venous thromboembolism (VTE) is controversial. Our objective was to determine if IVC filter placement in the setting of severe trauma effects the hazard of in-hospital pulmonary embolism (PE), deep venous thrombosis (DVT) and mortality.
This retrospective study recruited patients from a single Level I Trauma Center between 1/2008 and 12/2013. Inclusion criteria were age>15 years, Injury Severity Score (ISS)>15 and survival>24 h after hospital admission. Patients with VTE diagnosed prior to IVC filter placement were excluded. A Cox proportional hazards regression model was used, adjusting for immortal time bias with landmark analysis at predefined time after injury. Differences between IVC filter and non-IVC filter groups were adjusted using propensity score.
In total 1451 patients were reviewed; 282 patients received an IVC filter and 1169 patients had no IVC filter placed. The mean age was 45.9 vs. 56.9 years and the mean ISS was 29.8 vs. 22.6 in the IVC filter and the non-IVC filter group, respectively. IVC filter placement was not associated with the hazard of PE (HR = 0.46; 95 % CI, 0.12,1.70; P = 0.24) or mortality (HR = 1.02; 95 % CI 0.60,1.75; P = 0.93). However, IVC filter placement was associated with the hazard of DVT (HR = 2.73; 95 % CI, 1.28,5.85; P = 0.01).
In patients with severe trauma, those with prophylactic IVC filter placement did not have a reduced hazard of PE or mortality, but an increased hazard of DVT was observed.
在没有近期静脉血栓栓塞症（VTE）病史的严重创伤患者中使用下腔静脉（IVC）滤器存在争议。我们的目的是确定在严重创伤情况下放置IVC滤器是否会影响住院期间肺栓塞（PE）、深静脉血栓形成（DVT）的风险以及死亡率。
这项回顾性研究招募了2008年1月至2013年12月期间来自单一一级创伤中心的患者。纳入标准为年龄>15岁、损伤严重程度评分（ISS）>15且入院后存活>24小时。排除在放置IVC滤器之前被诊断为VTE的患者。使用Cox比例风险回归模型，并通过在损伤后的预定义时间进行标志性分析来调整不朽时间偏倚。使用倾向评分调整IVC滤器组和非IVC滤器组之间的差异。
总共审查了1451例患者；282例患者接受了IVC滤器，1169例患者未放置IVC滤器。IVC滤器组和非IVC滤器组的平均年龄分别为45.9岁和56.9岁，平均ISS分别为29.8和22.6。放置IVC滤器与PE风险（HR = 0.46；95%CI，0.12，1.70；P = 0.24）或死亡率（HR = 1.02；95%CI 0.60，1.75；P = 0.93）无关。然而，放置IVC滤器与DVT风险相关（HR = 2.73；95%CI，1.28，5.85；P = 0.01）。
在严重创伤患者中，预防性放置IVC滤器的患者PE风险或死亡率并未降低，但观察到DVT风险增加。
