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Comment & Response
July 2017

Inferior Vena Caval Filter Insertion in Trauma Patients—Reply

Author Affiliations
  • 1Department of Hematology, Boston University School of Medicine, Boston, Massachusetts
  • 2Data Coordinating Center, Boston University School of Public Health, Boston, Massachusetts
  • 3Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
JAMA Surg. 2017;152(7):707. doi:10.1001/jamasurg.2017.0474

In Reply We appreciate the letter from Fitzgerald and Mitra emphasizing that patient-specific indications for filter placement were not fully captured in our recently published data.1 The trauma surgery guidelines2 for inferior vena cava filter (IVCF) placement advocate that IVCFs be considered in high-risk trauma patients without a deep vein thrombosis or pulmonary embolism or in those with a contraindication for chemoprophylaxis, but the guidelines do not equivocally state when an IVCF should be placed. Therefore, it is not feasible to match based on indications for IVCF insertion, as treating physician discretion plays a significant role in determining the absolute contraindication for thromboprophylaxis and ascertaining who is considered high risk. In addition, mortality—our main outcome—is not necessarily affected by indication for IVCF placement; therefore, we chose to match patients based on criteria that do affect short-term and long-term mortality, such as age and injury severity.

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