There are numerous prevention strategies for deep venous thrombosis and subsequent pulmonary embolism: compression therapy, prophylactic anticoagulation, duplex scan surveillance for deep venous thrombosis with treatment after detection, and prophylactic inferior vena cava filter placement. The last therapy is invasive and expensive, but the report by Rogers and colleagues in this article confirms that it is highly effective. The authors report that prophylactic vena cava filters were used in 2% of their trauma patients. The filters were effective in preventing pulmonary embolism in all but 3 patients, although 1 had a fatal embolism. The complications of filter placement were relatively few and included procedure-related deep venous thrombosis (3%) and caval thrombosis (<1%). However, follow-up duplex scans of the vena cava were available on only 36%, so the latter figure may be higher. An especially valuable contribution of this article is the careful analysis of filter position and the logical conclusion that filter malposition permitted pulmonary embolism to develop even though the device was in place.
Richardson JD. Five-Year Follow-up of Prophylactic Vena Cava Filters in High-Risk Trauma Patients—Invited Commentary. Arch Surg. 1998;133(4):412. doi:10.1001/archsurg.133.4.412