Emergency Medicine Department, King Saud Medical City, Riyadh, Saudi Arabia.
Diagnostic and Interventional Radiology Department, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
J Intensive Care Med. 2023 Jun;38(6):491-510. doi: 10.1177/08850666231163141. Epub 2023 Mar 20.
Trauma is an independent risk factor for venous thromboembolism (VTE). Due to contraindications or delay in starting pharmacological prophylaxis among trauma patients with a high risk of bleeding, the inferior vena cava (IVC) filter has been utilized as alternative prevention for pulmonary embolism (PE). Albeit, its clinical efficacy has remained uncertain. Therefore, we performed an updated systematic review and meta-analysis on the effectiveness and safety of prophylactic IVC filters in severely injured patients. Three databases (MEDLINE, EMBASE, and Cochrane) were searched from August 1, 2012, to October 27, 2021. Independent reviewers performed data extraction and quality assessment. Relative risk (RR) at 95% confidence interval (CI) pooled in a randomized meta-analysis. A parallel clinical practice guideline committee assessed the certainty of evidence using the GRADE approach. The outcomes of interest included VTE, PE, deep venous thrombosis, mortality, and IVC filter complications. We included 10 controlled studies (47 140 patients), of which 3 studies (310 patients) were randomized controlled trials (RCTs) and 7 were observational studies (46 830 patients). IVC filters demonstrated no significant reduction in PE and fatal PE (RR, 0.27; 95% CI, 0.06-1.28 and RR, 0.32; 95% CI, 0.01-7.84, respectively) by pooling RCTs with low certainty. However, it demonstrated a significant reduction in the risk of PE and fatal PE (RR, 0.25; 95% CI, 0.12-0.55 and RR, 0.09; 95% CI, 0.011-0.81, respectively) by pooling observational studies with very low certainty. IVC filter did not improve mortality in both RCTs and observational studies (RR, 1.44; 95% CI, 0.86-2.43 and RR, 0.63; 95% CI, 0.3-1.31, respectively). In trauma patients, moderate risk reduction of PE and fatal PE was demonstrated among observational data but not RCTs. The desirable effect is not robust to outweigh the undesirable effects associated with IVC filter complications. Current evidence suggests against routinely using prophylactic IVC filters.
创伤是静脉血栓栓塞症（VTE）的独立危险因素。由于创伤患者存在出血高风险的禁忌证或开始药物预防的延迟，下腔静脉（IVC）滤器已被用作肺栓塞（PE）的替代预防措施。然而，其临床疗效仍不确定。因此，我们对严重创伤患者预防性 IVC 滤器的有效性和安全性进行了更新的系统评价和荟萃分析。从 2012 年 8 月 1 日到 2021 年 10 月 27 日，我们在三个数据库（MEDLINE、EMBASE 和 Cochrane）中进行了检索。独立审查员进行了数据提取和质量评估。随机荟萃分析中汇总了 95%置信区间（CI）的相对风险（RR）。一个平行的临床实践指南委员会使用 GRADE 方法评估证据的确定性。感兴趣的结果包括 VTE、PE、深静脉血栓形成、死亡率和 IVC 滤器并发症。我们纳入了 10 项对照研究（47140 例患者），其中 3 项研究（310 例患者）为随机对照试验（RCT），7 项为观察性研究（46830 例患者）。通过对低确定性的 RCT 进行荟萃分析，IVC 滤器并未显示出在 PE 和致命性 PE 方面的显著降低（RR，0.27；95%CI，0.06-1.28 和 RR，0.32；95%CI，0.01-7.84）。然而，通过对极低确定性的观察性研究进行荟萃分析，IVC 滤器显示出在 PE 和致命性 PE 风险方面的显著降低（RR，0.25；95%CI，0.12-0.55 和 RR，0.09；95%CI，0.011-0.81）。IVC 滤器在 RCT 和观察性研究中均未改善死亡率（RR，1.44；95%CI，0.86-2.43 和 RR，0.63；95%CI，0.3-1.31）。在创伤患者中，观察性数据显示 PE 和致命性 PE 的风险适度降低，但 RCT 并未显示。这种理想效果并不稳健，无法超过与 IVC 滤器并发症相关的不良效果。目前的证据表明，不建议常规使用预防性 IVC 滤器。
