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Surgical prophylaxis for pulmonary embolism

T A Leach1, J A Pastena, K G Swan

  • 1Department of Surgery, UMDNJ-New Jersey Medical School, Newark 07103.

The American Surgeon
|April 1, 1994
PubMed
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This summary is machine-generated.

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Trauma patients face high risks of fatal pulmonary embolism. Prophylactic Greenfield filter insertion significantly reduces fatal pulmonary embolism in high-risk trauma patients.

Area of Science:

  • Traumatology
  • Vascular Surgery
  • Critical Care Medicine

Background:

  • Trauma patients have a high risk of fatal pulmonary embolism (PE).
  • Standard prophylactic measures like anticoagulation and compression devices are often contraindicated in trauma patients.
  • Identifying and managing PE risk in trauma is a significant clinical challenge.

Purpose of the Study:

  • To evaluate the efficacy and safety of prophylactic inferior vena cava (IVC) filtration in high-risk trauma patients.
  • To reduce the incidence of fatal pulmonary embolism in this vulnerable population.

Main Methods:

  • Development and implementation of a protocol for prophylactic IVC filter placement (Greenfield filter) in trauma patients.
  • Retrospective analysis of 201 patients who received 205 Greenfield filters since 1986, with 200 placed prophylactically.

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  • Monitoring for mortality and morbidity associated with the filters and PE events.

    • Main Results:

    • No mortality was observed in patients who received prophylactic Greenfield filters.
    • Morbidity associated with IVC filter placement was minimal.
    • No patient with a Greenfield filter experienced a fatal pulmonary embolism during the study period.
    • Four patients died from PE before filter insertion.

    Conclusions:

    • Prophylactic inferior vena cava filtration using Greenfield filters is a safe and effective strategy for high-risk trauma patients.
    • Greenfield filters should be considered prophylactically as soon as logistically feasible after hospital admission for at-risk trauma patients.
    • This intervention significantly reduces the risk of fatal pulmonary embolism in trauma survivors.