Prophylactic Inferior Vena Cava Filter Placement Does Not Result in a Survival Benefit for Trauma Patients.
Prophylactic Inferior Vena Cava Filter Placement Does Not Result in a Survival Benefit for Trauma Patients.
复制标题
预防性放置下腔静脉过滤器不会给创伤患者带来生存获益。
DOI：
10.1097/sla.0000000000001434
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发表时间：
2015
影响因子：
9
通讯作者：
Birkmeyer,NancyJ
中科院分区：
文献类型：
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作者：
Hemmila,MarkR;Osborne,NicholasH;Henke,PeterK;Kepros,JohnP;Patel,SujalG;Cain-Nielsen,AnneH;Birkmeyer,NancyJ
目的：创伤患者是发生危及生命的静脉血栓栓塞症(VTE)事件的高危人群。我们研究了预防性下腔静脉滤器的使用、死亡率和VTE之间的关系。摘要背景数据：创伤患者预防性放置下腔静脉滤器的发生率有所增加。然而，关于预防性下腔静脉滤器的总体疗效方面的数据很少。方法：对2010-2014年创伤质量协作数据进行分析。排除无生命体征、创伤严重程度评分9分、住院3天或发生VTE事件后接受下腔静脉滤器治疗的患者。计算下腔静脉滤器放置的风险调整率，并将医院置于下腔静脉滤器使用的四分位数中。比较四分位数的死亡率。我们还确定了深静脉血栓形成(DVT)与下腔静脉滤器存在的相关性，说明了药物预防VTE的类型和开始的时间。结果：在39,456名患者中，803例(2%)放置了预防性下腔静脉滤器。医院在调整的下腔静脉滤器使用率方面表现出显著的变异性(0.6%至9.6%)。四分位数内的下腔静脉置入率分别为0.7%、1.3%、2.1%和4.6%。使用四分位数的下腔静脉滤器在死亡率方面没有变化。调整药物预防和患者因素，预防性下腔静脉滤器放置与DVT的发生率增加相关(OR=1.83；95%CI，1.15-2.93，P值=0.01)。结论：预防性下腔静脉滤器放置的高率对降低创伤患者死亡率没有影响，并与DVT事件的增加有关。背景第一个下腔静脉滤器是由外科医生Lazar J.Greenfield医学博士和石油工程师Garman O.Kimmel共同开发的。该装置最初被认为是以导管为基础的治疗急性大面积肺栓塞(PE)的辅助组件。1因此，放置下腔静脉滤器的最初目的是减少复发PE的发生率并降低相关死亡率。公认的下腔静脉滤器放置适应症具有典型的治疗性，包括近端深静脉血栓形成(DVT)或PE，以及抗凝、抗凝失败、大量PE或合并DVT的严重心肺疾病的禁忌症。2.
Objective:Trauma patients are at high risk for life-threatening venous thromboembolic (VTE) events. We examined the relationship between prophylactic inferior vena cava (IVC) filter use, mortality, and VTE.Summary Background Data:The prevalence of prophylactic placement of IVC filters has increased among trauma patients. However, there exists little data on the overall efficacy of prophylactic IVC filters with regard to outcomes.Methods:Trauma quality collaborative data from 2010 to 2014 were analyzed. Patients were excluded with no signs of life, Injury Severity Score< 9, hospitalization< 3 days, or who received IVC filter after occurrence of VTE event. Risk-adjusted rates of IVC filter placement were calculated and hospitals placed into quartiles of IVC filter use. Mortality rates by quartile were compared. We also determined the association of deep venous thrombosis (DVT) with the presence of an IVC filter, accounting for type and timing of initiation of pharmacological VTE prophylaxis.Results:A prophylactic IVC filter was placed in 803 (2%) of 39,456 patients. Hospitals exhibited significant variability (0.6% to 9.6%) in adjusted rates of IVC filter utilization. Rates of IVC placement within quartiles were 0.7%, 1.3%, 2.1%, and 4.6%, respectively. IVC filter use quartiles showed no variation in mortality. Adjusting for pharmacological VTE prophylaxis and patient factors, prophylactic IVC filter placement was associated with an increased incidence of DVT (OR= 1.83; 95% CI, 1.15–2.93, P-value= 0.01).Conclusions:High rates of prophylactic IVC filter placement have no effect on reducing trauma patient mortality and are associated with an increase in DVT events.BACKGROUNDThe first inferior vena cava (IVC) filter was developed by a surgeon: Lazar J. Greenfield, MD, and a petroleum engineer: Garman O. Kimmel. The device was originally conceived as a secondary component of a catheter-based approach to the management of acute massive pulmonary embolism (PE). 1 Hence, the initial purpose for placement of an IVC filter was to decrease the incidence of recurrent PE and reduce associated mortality. Accepted indications for IVC filter placement are characteristically therapeutic, including proximal deep vein thrombosis (DVT) or PE and contraindication to anticoagulation, failure of anticoagulation, massive PE, or severe cardiopulmonary disease with DVT. 2