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Prophylactic Inferior Vena Cava Filter Placement Does Not Result in a Survival Benefit for Trauma Patients
Mark R. Hemmila*1, Nicholas H. Osborne*1, Peter K. Henke1, John P. Kepros*2, Sujal G. Patel*3, Nancy J. Birkmeyer*1
1University of Michigan, Ann Arbor, MI;2Michigan State University, Lansing, MI;3Covenant Medical Center, Saginaw, MI

OBJECTIVE(S): Trauma patients are at high risk for life-threatening venous thromboembolic (VTE) events. We examined the relationship between prophylactic inferior vena cava (IVC) filter use, mortality, and VTE complications.
METHODS: Trauma quality collaborative data (2010-2014) were analyzed. Patients were excluded with no signs-of-life, injury severity score < 9, hospitalization < 3 days, or who received IVC filter after occurrence of a VTE event. Risk adjusted rates of IVC filter placement were calculated and hospitals placed into quartiles of IVC filter use. Mortality rates by quartile were compared. We determined the association of deep venous thrombosis (DVT) with presence of an IVC filter accounting for type and timing of initiation of chemical VTE prophylaxis in addition to standard trauma patient confounders.
RESULTS: A prophylactic IVC filter was placed in 799 (2%) of 39,114 patents. Hospitals exhibited significant variability (0.7 to 9.9%) in adjusted rates of IVC filter utilization (Figure-Left). Rates of IVC placement within quartiles were 0.8, 1.4, 2.3, and 4.3% respectively. IVC filter use quartiles showed no variance in mortality (Figure-Right). Adjusting for chemical prophylaxis and patient factors, prophylactic IVC filter placement was associated with an increased incidence of DVT (Odds Ratio=2.76; 95% CI, 1.96-3.9).

CONCLUSIONS: High rates of prophylactic IVC filter placement have no effect on reducing trauma patient mortality and are paradoxically associated with an increase in DVT events.

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