Trung Tran Thien, Bjarnason Haraldur, McDonald Jennifer, Skaga Nils Oddvar, Houghton Damon E, Kim Brian, Stavem Knut, Kløw Nils Einar
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
Department of Diagnostic Imaging and Intervention, Akershus University Hospital, Lørenskog, Norway.
Acta Radiol Open. 2021 Mar 9;10(3):2058460121999345. doi: 10.1177/2058460121999345. eCollection 2021 Mar.
Prophylactic use of inferior vena cava filters to prevent pulmonary embolism in trauma is controversial. The practice varies between hospitals and countries, in part due to conflicting evidence and guidelines.
To compare the effects of pulmonary embolism, deep venous thrombosis and mortality in two hospitals using prophylactic inferior vena cava filter placement or prophylactic anticoagulation alone.
Patients presenting with severe trauma were recruited from two level-1 trauma centres between January 2008 and December 2013. Recruited patients from an US hospital having prophylactic inferior vena cava filter inserted were compared to a Scandinavian hospital using prophylactic anticoagulation alone. Inclusion criteria were age >15 years, Injury Severity Score >15 and survival >24 h after hospital admission. Patients with venous thromboembolism diagnosed prior to inferior vena cava filter placement were excluded. A Cox proportional hazard regression model was used with adjustment for immortal time bias and predictor variables.
In total, 951 patients were reviewed, 282 from an US hospital having inferior vena cava filters placed and 669 from a Scandinavian hospital without inferior vena cava filters. The mean age was 45.9 vs. 47.4 years and the mean Injury Severity Score was 29.8 vs. 25.9, respectively. Inferior vena cava filter placement was not associated with the hazard of pulmonary embolism (Hazard ratio=0.43; 95% confidence interval (CI) 0.12, 1.45; P=0.17) or mortality (Hazard ratio=1.16; 95% CI 0.70, 1.95; P=0.56). However, an increased rate of deep venous thrombosis was observed with inferior vena cava filters in place (Hazard ratio=3.75; 95% CI 1.68, 8.36; P=0.001).
In severely injured trauma patients, prophylactic inferior vena cava filter placement was not associated with pulmonary embolism or mortality. However, inferior vena cava filters were associated with increased rate of deep venous thrombosis.
预防性使用下腔静脉滤器以预防创伤患者发生肺栓塞存在争议。不同医院和国家的做法各异，部分原因是证据和指南相互矛盾。
比较两家医院中，单独使用预防性下腔静脉滤器置入术或预防性抗凝治疗对肺栓塞、深静脉血栓形成和死亡率的影响。
2008年1月至2013年12月期间，从两家一级创伤中心招募严重创伤患者。将美国一家医院中接受预防性下腔静脉滤器置入术的患者与斯堪的纳维亚一家仅采用预防性抗凝治疗的医院中的患者进行比较。纳入标准为年龄>15岁、损伤严重度评分>15且入院后存活>24小时。排除在下腔静脉滤器置入术前已诊断为静脉血栓栓塞的患者。使用Cox比例风险回归模型，并对不朽时间偏倚和预测变量进行校正。
共纳入951例患者，其中美国一家医院有282例接受了下腔静脉滤器置入术，斯堪的纳维亚一家医院有669例未接受下腔静脉滤器置入术。平均年龄分别为45.9岁和47.4岁，平均损伤严重度评分分别为29.8和25.9。下腔静脉滤器置入术与肺栓塞风险（风险比=0.43；95%置信区间[CI] 0.12，1.45；P=0.17）或死亡率（风险比=1.16；95%CI 0.70，1.95；P=0.56）无关。然而，在下腔静脉滤器置入的情况下，深静脉血栓形成率有所增加（风险比=3.75；95%CI 1.68，8.36；P=0.001）。
在严重受伤的创伤患者中，预防性下腔静脉滤器置入术与肺栓塞或死亡率无关。然而，下腔静脉滤器与深静脉血栓形成率增加有关。
