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Semin intervent Radiol 2021; 38(01): 040-044
DOI: 10.1055/s-0041-1724013
Review Article

Venous Thromboembolism in Trauma: The Role of Anticoagulation and Inferior Vena Cava Filters

Nicholas Xiao
1   Division of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
,
Kush R. Desai
1   Division of Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
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Abstract

Venous thromboembolism (VTE) is a significant contributor to morbidity and mortality among patients with severe trauma. Historically, prophylactic inferior vena cava filters (IVCFs) were used in high-risk trauma patients with suspected risk factors for VTE, including prolonged immobilization, and concurrent contraindication to anticoagulation. Mounting data regarding the efficacy of IVCF in this cohort, as well as concerns regarding morbidity of an in situ IVCF, have challenged this practice paradigm. In this review, we discuss the comanagement of VTE and trauma, including anticoagulation and the use of IVCF.

Keywords

trauma - inferior vena cava filters - deep vein thrombosis - pulmonary embolism - venous thromboembolism - interventional radiology - anticoagulation - hemorrhage


Publication History

Article published online:
15 April 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Beckman MG, Hooper WC, Critchley SE, Ortel TL. Venous thromboembolism: a public health concern. Am J Prev Med 2010; 38 (4, Suppl): S495-S501
    CrossrefPubMedGoogle Scholar
  • 2 Geerts WH, Code KI, Jay RM, Chen E, Szalai JP. A prospective study of venous thromboembolism after major trauma. N Engl J Med 1994; 331 (24) 1601-1606
    CrossrefPubMedGoogle Scholar
  • 3 Heit JA, Silverstein MD, Mohr DN, Petterson TM, O'Fallon WM, Melton III LJ. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med 2000; 160 (06) 809-815
    CrossrefPubMedGoogle Scholar
  • 4 Ho KM, Burrell M, Rao S, Baker R. Incidence and risk factors for fatal pulmonary embolism after major trauma: a nested cohort study. Br J Anaesth 2010; 105 (05) 596-602
    CrossrefPubMedGoogle Scholar
  • 5 Knudson MM, Lewis FR, Clinton A, Atkinson K, Megerman J. Prevention of venous thromboembolism in trauma patients. J Trauma 1994; 37 (03) 480-487
    CrossrefPubMedGoogle Scholar
  • 6 Toker S, Hak DJ, Morgan SJ. Deep vein thrombosis prophylaxis in trauma patients. Thrombosis 2011; 2011: 505373
    CrossrefPubMedGoogle Scholar
  • 7 Ruiz AJ, Hill SL, Berry RE. Heparin, deep venous thrombosis, and trauma patients. Am J Surg 1991; 162 (02) 159-162
    CrossrefPubMedGoogle Scholar
  • 8 Selby R, Geerts W, Ofosu FA. et al. Hypercoagulability after trauma: hemostatic changes and relationship to venous thromboembolism. Thromb Res 2009; 124 (03) 281-287
    CrossrefPubMedGoogle Scholar
  • 9 Owings JT, Bagley M, Gosselin R, Romac D, Disbrow E. Effect of critical injury on plasma antithrombin activity: low antithrombin levels are associated with thromboembolic complications. J Trauma 1996; 41 (03) 396-405 , discussion 405–406
    CrossrefPubMedGoogle Scholar
  • 10 Engelman DT, Gabram SG, Allen L, Ens GE, Jacobs LM. Hypercoagulability following multiple trauma. World J Surg 1996; 20 (01) 5-10
    CrossrefPubMedGoogle Scholar
  • 11 Geerts WH, Jay RM, Code KI. et al. A comparison of low-dose heparin with low-molecular-weight heparin as prophylaxis against venous thromboembolism after major trauma. N Engl J Med 1996; 335 (10) 701-707
    CrossrefPubMedGoogle Scholar
  • 12 Osler T, Rogers F. Prophylaxis against venous thromboembolism after major trauma. N Engl J Med 1997; 336 (08) 586 , author reply 586–587
    CrossrefPubMedGoogle Scholar
  • 13 Geerts WH, Bergqvist D, Pineo GF. et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133 (6, Suppl): 381S-453S
    CrossrefPubMedGoogle Scholar
  • 14 Kearon C, Akl EA, Ornelas J. et al. Antithrombotic therapy for VTE disease: CHEST Guideline and Expert Panel Report. Chest 2016; 149 (02) 315-352
    CrossrefPubMedGoogle Scholar
  • 15 Jacobs BN, Cain-Nielsen AH, Jakubus JL. et al. Unfractionated heparin versus low-molecular-weight heparin for venous thromboembolism prophylaxis in trauma. J Trauma Acute Care Surg 2017; 83 (01) 151-158
    CrossrefPubMedGoogle Scholar
  • 16 Bush S, LeClaire A, Hampp C, Lottenberg L. Review of a large clinical series: once- versus twice-daily enoxaparin for venous thromboembolism prophylaxis in high-risk trauma patients. J Intensive Care Med 2011; 26 (02) 111-115
    CrossrefPubMedGoogle Scholar
  • 17 Byrne JP, Geerts W, Mason SA. et al. Effectiveness of low-molecular-weight heparin versus unfractionated heparin to prevent pulmonary embolism following major trauma: a propensity-matched analysis. J Trauma Acute Care Surg 2017; 82 (02) 252-262
    CrossrefPubMedGoogle Scholar
  • 18 Weitz JI. Low-molecular-weight heparins. N Engl J Med 1997; 337 (10) 688-698
    CrossrefPubMedGoogle Scholar
  • 19 Hirsh J, Raschke R. Heparin and low-molecular-weight heparin: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004; 126 (3, Suppl): 188S-203S
    CrossrefPubMedGoogle Scholar
  • 20 Berndtson AE, Costantini TW, Lane J, Box K, Coimbra R. If some is good, more is better: an enoxaparin dosing strategy to improve pharmacologic venous thromboembolism prophylaxis. J Trauma Acute Care Surg 2016; 81 (06) 1095-1100
    CrossrefPubMedGoogle Scholar
  • 21 Ko A, Harada MY, Barmparas G. et al. Association between enoxaparin dosage adjusted by anti-factor Xa trough level and clinically evident venous thromboembolism after trauma. JAMA Surg 2016; 151 (11) 1006-1013
    CrossrefPubMedGoogle Scholar
  • 22 Walker CK, Sandmann EA, Horyna TJ, Gales MA. Increased enoxaparin dosing for venous thromboembolism prophylaxis in general trauma patients. Ann Pharmacother 2017; 51 (04) 323-331
    CrossrefPubMedGoogle Scholar
  • 23 Shaikh S, Boneva D, Hai S, McKenney M, Elkbuli A. Venous thromboembolism chemoprophylaxis regimens in trauma and surgery patients with obesity: a systematic review. J Trauma Acute Care Surg 2020; 88 (04) 522-535
    CrossrefPubMedGoogle Scholar
  • 24 Byrne JP, Mason SA, Gomez D. et al. Timing of pharmacologic venous thromboembolism prophylaxis in severe traumatic brain injury: a propensity-matched cohort study. J Am Coll Surg 2016; 223 (04) 621-631.e5
    CrossrefPubMedGoogle Scholar
  • 25 Norwood SH, Berne JD, Rowe SA, Villarreal DH, Ledlie JT. Early venous thromboembolism prophylaxis with enoxaparin in patients with blunt traumatic brain injury. J Trauma 2008; 65 (05) 1021-1026 , discussion 1026–1027
    CrossrefPubMedGoogle Scholar
  • 26 Strom RG, Frempong-Boadu AK. Low-molecular-weight heparin prophylaxis 24 to 36 hours after degenerative spine surgery: risk of hemorrhage and venous thromboembolism. Spine 2013; 38 (23) E1498-E1502
    CrossrefPubMedGoogle Scholar
  • 27 Bratton SL, Chestnut RM, Ghajar J. et al; Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons, Joint Section on Neurotrauma and Critical Care, AANS/CNS. Guidelines for the management of severe traumatic brain injury. XV. Steroids. J Neurotrauma 2007; 24 (Suppl. 01) S91-S95
    CrossrefPubMedGoogle Scholar
  • 28 Eberle BM, Schnüriger B, Inaba K. et al. Thromboembolic prophylaxis with low-molecular-weight heparin in patients with blunt solid abdominal organ injuries undergoing nonoperative management: current practice and outcomes. J Trauma 2011; 70 (01) 141-146 , discussion 147
    CrossrefPubMedGoogle Scholar
  • 29 Kwok AM, Davis JW, Dirks RC, Wolfe MM, Kaups KL. Time is now: venous thromboembolism prophylaxis in blunt splenic injury. Am J Surg 2016; 212 (06) 1231-1236
    CrossrefPubMedGoogle Scholar
  • 30 Rostas JW, Manley J, Gonzalez RP. et al. The safety of low molecular-weight heparin after blunt liver and spleen injuries. Am J Surg 2015; 210 (01) 31-34
    CrossrefPubMedGoogle Scholar
  • 31 Nathens AB, McMurray MK, Cuschieri J. et al. The practice of venous thromboembolism prophylaxis in the major trauma patient. J Trauma 2007; 62 (03) 557-562 , discussion 562–563
    CrossrefPubMedGoogle Scholar
  • 32 Menaker J, Stein DM, Scalea TM. Incidence of early pulmonary embolism after injury. J Trauma 2007; 63 (03) 620-624
    CrossrefPubMedGoogle Scholar
  • 33 Khansarinia S, Dennis JW, Veldenz HC, Butcher JL, Hartland L. Prophylactic Greenfield filter placement in selected high-risk trauma patients. J Vasc Surg 1995; 22 (03) 231-235 , discussion 235–236
    CrossrefPubMedGoogle Scholar
  • 34 Rosenthal D, McKinsey JF, Levy AM, Lamis PA, Clark MD. Use of the Greenfield filter in patients with major trauma. Cardiovasc Surg 1994; 2 (01) 52-55
    PubMedGoogle Scholar
  • 35 Rogers FB, Cipolle MD, Velmahos G, Rozycki G, Luchette FA. Practice management guidelines for the prevention of venous thromboembolism in trauma patients: the EAST practice management guidelines work group. J Trauma 2002; 53 (01) 142-164
    CrossrefPubMedGoogle Scholar
  • 36 Van Ha TG. Complications of inferior vena caval filters. Semin Intervent Radiol 2006; 23 (02) 150-155
    Article in Thieme ConnectPubMedGoogle Scholar
  • 37 Haut ER, Garcia LJ, Shihab HM. et al. The effectiveness of prophylactic inferior vena cava filters in trauma patients: a systematic review and meta-analysis. JAMA Surg 2014; 149 (02) 194-202
    CrossrefPubMedGoogle Scholar
  • 38 Kidane B, Madani AM, Vogt K, Girotti M, Malthaner RA, Parry NG. The use of prophylactic inferior vena cava filters in trauma patients: a systematic review. Injury 2012; 43 (05) 542-547
    CrossrefPubMedGoogle Scholar
  • 39 Mismetti P, Laporte S, Pellerin O. et al; PREPIC2 Study Group. Effect of a retrievable inferior vena cava filter plus anticoagulation vs anticoagulation alone on risk of recurrent pulmonary embolism: a randomized clinical trial. JAMA 2015; 313 (16) 1627-1635
    CrossrefPubMedGoogle Scholar
  • 40 Regner JL, Shaver CN, Group SMT. SWSC Multicenter Trials Group. Determining the impact of culture on venous thromboembolism prevention in trauma patients: a Southwestern Surgical Congress Multicenter trial. Am J Surg 2019; 217 (06) 1030-1036
    CrossrefPubMedGoogle Scholar
  • 41 Bandle J, Shackford SR, Sise CB, Knudson MM, Group CS. CLOTT Study Group. Variability is the standard: the management of venous thromboembolic disease following trauma. J Trauma Acute Care Surg 2014; 76 (01) 213-216
    CrossrefPubMedGoogle Scholar
  • 42 Kaufman JA, Kinney TB, Streiff MB. et al. Guidelines for the use of retrievable and convertible vena cava filters: report from the Society of Interventional Radiology multidisciplinary consensus conference. Surg Obes Relat Dis 2006; 2 (02) 200-212
    CrossrefPubMedGoogle Scholar
  • 43 Sarosiek S, Rybin D, Weinberg J, Burke PA, Kasotakis G, Sloan JM. Association between inferior vena cava filter insertion in trauma patients and in-hospital and overall mortality. JAMA Surg 2017; 152 (01) 75-81
    CrossrefPubMedGoogle Scholar
  • 44 Ho KM, Rao S, Honeybul S. et al. A multicenter trial of vena cava filters in severely injured patients. N Engl J Med 2019; 381 (04) 328-337
    CrossrefPubMedGoogle Scholar
  • 45 Achaibar K, Waldmann C, Taccone FS. The Angel catheter for the prevention of pulmonary embolism: combining an IVC filter and a triple-lumen central venous catheter. Expert Rev Med Devices 2019; 16 (03) 183-186
    CrossrefPubMedGoogle Scholar
  • 46 Matusov Y, Weinberg AS, Liang R, Meza J, Friedman O, Tapson VF. Use of the bedside-placed Angel catheter IVC filter for venous thromboembolic disease in critically ill medical patients. J Intensive Care Med 2020; 35 (03) 225-232
    CrossrefPubMedGoogle Scholar
  • 47 Serednicki W, Dobrowolska E, Kałuża K, Kopacz M, Wordliczek J. Angel(®) Catheter use for pulmonary embolism prophylaxis in a polytrauma patient. Injury 2015; 46 (06) 1167-1170
    CrossrefPubMedGoogle Scholar
  • 48 Taccone FS, Bunker N, Waldmann C. et al. A new device for the prevention of pulmonary embolism in critically ill patients: results of the European Angel Catheter Registry. J Trauma Acute Care Surg 2015; 79 (03) 456-462
    CrossrefPubMedGoogle Scholar
  • 49 Ho KM, Rao S, Rittenhouse KJ, Rogers FB. Use of the Trauma Embolic Scoring System (TESS) to predict symptomatic deep vein thrombosis and fatal and non-fatal pulmonary embolism in severely injured patients. Anaesth Intensive Care 2014; 42 (06) 709-714
    CrossrefPubMedGoogle Scholar
  • 50 Black SR, Howard JT, Chin PC, Starr AJ. Toward a more robust prediction of pulmonary embolism in trauma patients: a risk assessment model based on 38,000 patients. J Orthop Trauma 2016; 30 (04) 200-207
    CrossrefPubMedGoogle Scholar
  • 51 Gearhart MM, Luchette FA, Proctor MC. et al. The risk assessment profile score identifies trauma patients at risk for deep vein thrombosis. Surgery 2000; 128 (04) 631-640
    CrossrefPubMedGoogle Scholar