Until today, there was no evidence warranting the early implantation of a vena cava filter for the reduction of the risk of pulmonary embolism in patients with severe trauma and contraindication to prophylactic anticoagulation.
This article, soon to be published in the New England Medical Journal (NEJM), brings us such evidence and we surrender to it. Early prophylactic placement of a vena cava filter after severe trauma did not reduce the incidence of symptomatic pulmonary embolism or death at 90 days compared with no implantation of a filter.
This multicenter controlled trial enrolled 240 patients with severe trauma (Injury Severity Score >15; scores range from 0 to 75, and the highest the score, the highest the severity]) who had a contraindication to anticoagulation, and randomized them to filter implantation within the first 72 hours after admission vs. no implantation.
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The primary endpoint was a composite of symptomatic pulmonary embolism at 8 to 90 days in the subgroup of patients who survived at least 7 days and who did not receive prophylactic anticoagulation during that time.
The mean age was 39 years old and the mean Injury Severity Score was 27.
Early filter implantation did not result in lower incidence of the primary endpoint (13.9% in the vena cava filter group vs. 14.4% in the control group; p = 0.98).
No patient in the filter group developed pulmonary embolism while 5 patients (14.7%) in the control group, including one who died, did experience such complication. Entrapped thrombus was found in the filter in 6 patients.
Conclusion
Early prophylactic placement of a vena cava filter in patients with severe trauma did not result in a lower incidence of symptomatic pulmonary embolism or death at 90 days vs. no filter implantation in patients with contraindication to prophylactic anticoagulation.
Original Title: A Multicenter Trial of Vena Cava Filters in Severely Injured Patients.
Reference: Kwok M. Ho et al. N Engl J Med. 2019 Jul 7. [Epub ahead of print].
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