PURPOSE: Thromboembolic complications cause significant morbidity and mortality in orthopedic patients. We describe the preoperative insertion of retrievable inferior vena cava filters (RIVCF) for primary thromboprophylaxis in high-risk orthopedic patients. We hypothesized that RIVCF is safe and effective at minimizing perioperative pulmonary emboli (PE) in this population. Removing a RIVCF may avoid long-term complications including the need for continued anticoagulation, filter migration, filter occlusion and deep venous thrombosis (DVT).
METHODS: One hundred and nine orthopedic patients underwent RIVCF placement between August 2003 and February 2007. Twenty eight of 109 (26%) filters were inserted preoperatively for primary thromboprophylaxis. Indications included recent trauma (67%), pulmonary hypertension (30%), history of venous thromboembolism (VTE) (30%), severe hypoxemia (26%), thrombophilia (26%), and severe COPD (26%). Patients underwent trauma surgery (50%), spine surgery (29%), hip or knee joint surgery (14%), and other surgery (7%). Additional VTE prophylaxis included pneumatic compression devices (67%), anticoagulant therapy (61%), and ambulation (19%). Patients were followed after discharge for a mean of 180 days.
RESULTS: No complications were associated with insertion of the RIVCF and no subsequent filter complications were reported. No perioperative PE's were detected during acute hospitalization. No DVTs or PEs were reported during the study period. Fifteen (54%) filters underwent removal attempts and all were successful. Removed filters (n=15) remained in place an average of 51 days (median 37 days, range 4 days to 149 days). Filters were left in place (n=13) for therapeutic reasons (31%), because patients were scheduled for further surgery (23%), died after hospital discharge of non-VTE cause (23%), were scheduled for future removal (8%) or were lost to follow-up (n=2, 15%).
CONCLUSION: The use of preoperative RIVCF for primary thromboprophylaxis is a safe and effective means of minimizing perioperative VTE in high-risk orthopedic patients.
CLINICAL IMPLICATIONS: Insertion of a RVICF preoperatively should be considered for primary thromboprophylaxis in high-risk orthopedic patients in addition to conventional mechanical or chemoprophylactic measures.
DISCLOSURE: Ezra Dweck, No Financial Disclosure Information; No Product/Research Disclosure Information