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European Journal of Trauma and Emergency Surgery

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01-12-2021 | Phlebothrombosis | Original Article

Inferior vena cava filters reduce symptomatic but not fatal pulmonary emboli after major trauma: a meta-analysis with trial sequential analysis

Authors: Mariam Shariff, Ashish Kumar, Devina Adalja, Rajkumar Doshi

Published in: European Journal of Trauma and Emergency Surgery | Issue 6/2021

Abstract

Introduction

The prophylactic use of inferior vena cava filters among patients with major trauma is researched by several controlled studies with contradicting results. We performed an updated meta-analysis with trial sequential analysis of controlled studies probing the prophylactic use of inferior cava filters on the development of symptomatic and fatal pulmonary embolism (PE) in patients with major trauma.

Methods

A systematic electronic search across PubMed, Cochrane and DARE databases was executed from the debut of the databases up to September 15, 2019 for pertinent articles. The inclusion criteria being, controlled trials (randomized/ observational) investigating the prophylactic inferior vena cava filter placement among patients with major trauma juxtaposed to controls and reporting PE. Major trauma was defined as an injury severity score (ISS) > 15 or any trauma delaying the initiation of pharmacological venous thromboembolic [VTE] prophylaxis.

Results

A total of ten studies were included in the final analysis, of which two were randomized control trials. The use of prophylactic inferior vena cava filters was associated with a reduced risk of symptomatic PE among subjects with major trauma, RR: 0.27, CI 0.12–0.58, P value < 0.05, I² = 0%, χ² p-value = 0.85, the evidence was further reinforced by a trial sequential analysis. However, the use of inferior vena cava filters was not associated with a decreased risk of fatal PE among subjects with major trauma, RR: 0.29, CI 0.08–1.10, P value = 0.07, I² = 0%, χ² p-value = 0.73.

Conclusion

The use of inferior vena cava filters curtailed the risk of symptomatic PE, the result further strengthened by trial sequential analysis. However, the present evidence fails to delineate a beneficial role of prophylactic inferior vena cava filter placement in reducing fatal PE among patients with major trauma. The possibility of Type II error cannot be excluded from this estimate.

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Title: Inferior vena cava filters reduce symptomatic but not fatal pulmonary emboli after major trauma: a meta-analysis with trial sequential analysis
Authors: Mariam Shariff
Ashish Kumar
Devina Adalja
Rajkumar Doshi
Publication date: 01-12-2021
Publisher: Springer Berlin Heidelberg
Keyword: Phlebothrombosis
Published in: European Journal of Trauma and Emergency Surgery / Issue 6/2021
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-020-01350-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Inferior vena cava filters reduce symptomatic but not fatal pulmonary emboli after major trauma: a meta-analysis with trial sequential analysis

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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