Table 6.
Prophylactic Vena Cava Insertion in Patients With Traumatic SCI
| Author/ Year/ Country/ PEDro/ D&B scores | Eligibility Criteria | Study Design and Methods | Outcome Measures | Results |
|---|---|---|---|---|
| Maxwell et al, 200245 USA D&B=19 |
Inclusion: patients with SCI. Exclusion: not specified. |
Case series-111 SCI patients underwent DVT prophylaxis with sequential compression devices and unfractionated heparin 5000 units subcutaneously every 12h (changed to 30mg s/c q12h). | Injury severity score; incidence of DVT and PE. | One hundred and eleven of 8269 SCI patients, with incidences of DVT and PE of 9% and 1.8%, respectively. Around 41% were paraplegics and 58.6% tetraplegics: 17.1% of patients had severe closed-head injury. Hospital stay: 23±20 days for SCI patients. Incidences of DVT and PE in those patients with SCDs alone were 7.1% and 2.3%; for SCDs plus s/c heparin, the incidences were 11.1% and 2.8%; and for SCDs plus LMWH, incidences were 7.4% and 0%, respectively. Incidence of DVT in SCI patients with long bone fractures was 37.5%, significantly greater than for total SCI population (P<.02). |
| Wilson et al,199442 USA D&B=18 |
Inclusion: all SCI patients admitted to medical center of Vermont. Exclusion: not specified. |
Case-control-15 SCI patients had prophylactic vena cava filter inserted. | Injury severity score; impedance plethysmography; lower extremity duplex ultrasound. | No complications were associated with vena cava filter insertion. No patients developed venous thrombosis during acute hospitalization (median, 22d); no patients developed PE after filter insertion. At follow-up, deep abdominal duplex scan of the vena cava was performed, with a 30-day patency of 100% and 1-year patency of 81.8%. The lower rate at 1 year follow-up felt to represent the trapping of thrombus. |
| Khansarinia et al,43 Mexico 1995 |
Inclusion: injury severity score of greater than 9; expected to survive longer than 24 hours; met 1 of the following criteria: (1) severe head injury with prolonged ventilator dependence; (2) severe head injury with multiple lower-extremity fractures; (3) SCI with or without paralysis; (4) major abdominal or pelvic penetrating venous injury; (5) pelvic fracture with lower extremity fractures. Exclusion: not specified. |
Case-control: 324 individuals with SCI admitted over a 2- year period to a trauma center. Those in treatment group (n=108) underwent PGF placement. The remaining subjects (n=216) were a historical control group. | Injury Severity Score; Glasgow Coma Scale; fluoroscopy; B- mode ultrasonography; ventilation/perfusion scan; pulmonary arteriography. | There were no statistical differences between the 2 groups. PGF group no patients had a PE; control group, 13 patients had PE, 9 of which were fatal. Differences significant for PE (P<.009) and PE-related death (P<.03). Mortality rate: PGF group 18 (16%) of 108 versus controls 47 (22%) of 216; P is not significant. |
| Rogers et al 199544 USA D&B=13 |
Inclusion: not specified. Exclusion: not specified. |
Case-control-63 patients were selected but only 55 were inserted with prophylactic vena cava filters. | Incidence of PE. | Time from admission to prophylactic insertion of vena cava filter was 4.3±3.9 days. Three cases of DVT occurred after discharge from hospital. Overall 19 patients (30%) with prophylactic vena cava filters developed a DVT. When incidence of PE was compared in a high- risk trauma population before and after inserting a prophylactic vena cava filter, there was a significant PE reduction (P<.001). |
| Jarrell et al, 198341 USA D&B=11 |
Inclusion: SCI patients. Exclusion: not specified. |
Case Series-21 SCI patients had Kim-Ray Greenfield filter inserted into IVC below renal veins to interrupt the IVC. Patients remained on full anti-coagulation throughout performance of procedure. A repeat IVC gram was performed, if there was any doubt about position of filter or patency of IVC. | Documentation of DVT or PE. | All patients with an indication for Kim-Ray Greenfield filter were technically capable of having device inserted. There was 1 death due to PE in patient with a filter. No other suspected or proven PE after insertion of a filter since institution of policy requiring preoperative IVC gram and postoperative studies to prove proper location. Follow-up of 23 remaining patients revealed 2 instances of IVC thrombosis. |
Abbreviations: D&B, Downs and Black quality assessment scale score22; IVC, inferior vena cava; PGF, prophylactic Greenfield filter.