Prophylactic vena cava filters for trauma patients: a systematic review of the literature

Although various methods of preventing venous thromboembolism (VTE) have proven effective in many patient populations [1], neither low-dose heparin (LDH) nor mechanical prophylaxis using sequential compression devices (SCD) has proven better than no prophylaxis in patients who are at high risk for VTE due tomajor trauma [2]. Additionally, low-molecular-weight heparin (LMWH) may be no better than LDH in the prevention of pulmonary embolism (PE) [2]. In response to the limited effectiveness of standard preventive measures, more and more hospitals have adopted the practice of placing prophylactic inferior vena cava (IVC) filters to prevent PE in high risk trauma patients [2]. Athanasoulis et al. [3] reported the indications for placement of 1753 IVC filters from 1973 to 1998 at the Massachusetts General Hospital. Prophylaxis was not an indication until 1982. From that time until 1998, a total of 83 filters (4.7%) were placed for prophylaxis. In 1998, the percentage of prophylactic filters surpassed 15%. Greenfield et al. [4] reported a similar experience at the University of Michigan. Is there evidence to support the safety and efficacy of prophylactic IVC filter placement in patients at high risk of PE after major trauma? To address this question, we conducted a systematic review of the literature that describes the use of IVC filters in this clinical setting.