Patients who have a traumatic spinal cord injury are better off without an IVC filter, according to researchers.
Surgeons from New York City’s Jacobi Medical Center and Yeshiva University’s Albert Einstein College of Medicine evaluated large volumes of data to find out about the efficacy and safety of inferior vena cava (IVC) filters in spinal cord injury patients. The information from a national databank was used to compare the results of those who have received a filter to those who have received chemoprophylaxis alone, General Surgery News reports.
The surgeons’ goal was to gain clarity as to whether or not an IVC filter for spinal cord injury patients is even necessary. The surgeons presented the findings at the 2017 New York Surgical Society Meeting where the Philadelphia Academy of Surgery and the Boston Surgical Society were in attendance.
“We wanted to investigate whether there was a benefit to prophylactic IVC filters in patients suffering from traumatic spinal cord injuries. Or should we as surgeons take a conservative approach when it comes to filter placement, considering the cost–benefit and associated morbidity in our critically ill trauma patients?” said Ravi N. Kapadia, MD, a general surgery chief resident at Jacobi Medical Center and Montefiore Medical Center, Albert Einstein College of Medcine.
Dr. Kapadia and Aksim Rivera, MD, senior study contributor and assistant professor of surgery and cardiovascular and thoracic surgery at Jacobi Medical Center, set out with a team to go through 3.6 million charts provided by the American College of Surgeons’ National Trauma Data Bank from the last four years. According to the data, nearly 69,000 patients with traumatic spinal cord injury received an IVC filter. Of those patients, 10.1 percent were more likely to experience a pulmonary embolism (PE) than those who used chemoprophylaxis, such as blood thinners, alone.
“The filter in and of itself is thrombogenic,” said Dr. Kapadia, “which can explain the higher rate of pulmonary emboli in the filter group. Additionally, it is not uncommon to see small clots on top of the filter when we remove them. These small clots can manifest as subclinical PE, so the rate of pulmonary embolism is probably much higher. We just happen to only know about those that manifest clinically.”
Chemical prophylaxis paired with a sequential compression device (SCD) is far more efficient in cost and avoidance of complications than an IVC filter, the study finds. Dr. Kapadia encourages hospitals to reconsider any mandate that pushes IVC filter use in traumatic spinal cord injury patients.
Only a small number of patients ever return to have the filter removed after the risk of PE has subsided, either due to a lack of patient compliance or due to the hospital’s failure to follow up with the patient.
“Follow-up is a problem in a trauma population,” said Dr. Kapadia. “It’s a factor we should consider when we want to limit who gets a filter. But in some cases, such as patients with high cervical cord injuries or complex pelvic fractures, the utility of an IVC filter should not be undermined. This is an example of where the benefit outweighs the risk.”
Dr. Michael S. Weingarten, professor at Drexel University College of Medicine and medical director of the Drexel Comprehensive Wound Healing Program in Philadelphia, points out that IVC filters are overused. “The literature shows we’re putting in too many filters and there are way too many complications such as occlusion, fracture, and if the patient will ever come back to have the filter removed. So the cost-effectiveness of an IVC filter is highly questionable.”