USE OF INFERIOR VENA CAVA FILTERS

Inferior Vena Cava Filter (IVCF) placement in the combat theater may be used for:

1. Primary prophylaxis (no evidence of VTE disease at the time of placement).
2. Secondary prophylaxis (documented DVT) of PE in the polytrauma patient.

Patients felt to be at particularly high risk for VTE development and who have a clinical contraindication to prophylactic anticoagulation are the most likely to have an IVCF placed.

Most series examining the use of IVCF placement for primary prophylaxis of PE in the trauma patient support a low rate of subsequent PE (1.6%), although the studies are of variable design and a strong consensus supporting this clinical practice cannot be made based upon available data.29 There is no evidence that prophylactic use of IVCF is associated with a decreased PE rate or fatal PE rate. It should be noted that when IVCF are placed they are done so to prevent FATAL Pulmonary Emboli as DVT and PE still can occur.30-34

IVCF has no benefit in the prevention of DVTs and may be associated with the development of IVC and Deep Venous Thrombosis.14,37

The role of duplex ultrasound in the diagnosis of DVT should be reserved for the symptomatic patient. Serial screening duplex ultrasound for the diagnosis of DVT is not recommended.14

For those asymptomatic trauma patients with significant injuries and gaps in pharmacologic prophylaxis, venous compression duplex may be considered.52 If a DVT or PE is identified, then therapeutic anticoagulation is necessary per current guidelines, and if it is contraindicated, then an inferior vena cava (IVC) filter should be considered.

Refer to Appendix B for additional recommendations regarding IVC filters.