Removal of rIVCFs before discharge once patients are appropriately anticoagulated is a safe strategy to improve retrieval rates.Severely injured trauma patients are at high risk of developing deep venous thombosis (DVT) and pulmonary emboli (PE), and may have contraindications to prophylactic or therapeutic anticoagulation. Retrievable inferior vena cava filters (rIVCFs) are used to act as a mechanical obstruction to prevent PE in high risk populations and those with DVT who cannot be anticoagulated.

Removal of Retrievable Inferior Vena Cava Filters before discharge
Is it associated with increased incidence of pulmonary embolism?
Robbins, Justin M., BS1; Garwe, Tabitha, PhD, MPH2,3; McCarthy, Cullen K., MD2; Sarwar, Zoona, MS2; Gonzalez, Robert A., BS1; Zander, Tyler, BS1; Jalla, Aditi N., MD2; Conner, Keri S., DO4; Stewart, Kenneth, PhD, MPH2; Albrecht, Roxie M., MD2

Journal of Trauma and Acute Care Surgery: June 3, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/TA.0000000000002395
2019 WTA Podium Paper: PDF Only
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BACKGROUND Severely injured trauma patients are at high risk of developing deep venous thombosis (DVT) and pulmonary emboli (PE), and may have contraindications to prophylactic or therapeutic anticoagulation. Retrievable inferior vena cava filters (rIVCFs) are used to act as a mechanical obstruction to prevent PE in high risk populations and those with DVT who cannot be anticoagulated.The removal rate of rIVCFs is variable in trauma centers, including our previous published rate of 50 – 89%/year. Indwelling filters carry a risk of significant morbidity and the success of retrieval decreases as the dwell time increases. We hypothesized that once patients could receive appropriate prophylactic or therapeutic anticoagulation, rIVCF could be removed before hospital discharge without impact on occurrence or recurrence of PE.

METHODS: All trauma patients with rIVCF placed and removed between 1/2006 - 8/2018 were reviewed. We collected data from record review from admission to 6 months post filter removal, including demographics, filter indication, filter type, dwell time, placement and removal complications, antithrombosis medications, location of VTE, complications, and discharge disposition. Exposure of interest was timing of filter removal: before (BEF) or after hospital discharge (AFT). The outcome of interest was whether the patient had a documented PE within 6 months of filter removal.

RESULTS: A total of 281 rIVCFs were placed, 218 were eligible for removal, 72.4% (158/218) were retrieved with 63% (100/158) removed before discharge. Mean filter duration was 26 and 103 days for the before and after group respectively. No differences (p> 0.05) were noted in the distribution of demographic and clinical factors except for filter indication (VTE indication, 95% in AFT vs 74% in BEF, p=0.0043). Post-removal PE rates were 0% BEF and 1% AFT (Fisher's Exact p=1.000).

CONCLUSIONS: Our results suggest that removal of rIVCFs before discharge once patients are appropriately anticoagulated is a safe strategy to improve retrieval rates.

Level of Evidence Level IV

© 2019 Lippincott Williams & Wilkins, Inc.

Alexandros Sfakianakis
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