J Trauma Crit Care 2018 Volume 2 Issue 1 7 http://www.alliedacademies.org/trauma-and-critical-care/ Research Article Introduction The risk of venous thromboembolism (VTE) is very high in trauma patients, secondary to tissue injury, venous status from immobilization, and thrombophilia. As such, early initiation of VTE prophylaxis is essential in this population. The competing risks of life threatening hemorrhage and VTE need to be considered very carefully. Potential approaches to VTE prophylaxis include pharmacologic means, and mechanical devices. For patients unable to receive pharmacologic VTE prophylaxis (due to expanding intracranial hemorrhage, paraspinal hematomas, multiple surgeries, or other reasons), retrievable inferior vena cava filters (rIVCFs) may be placed until low molecular weight heparin (LMWH) can be initiated as a means to prevent development or mitigate the effects of developing pulmonary embolism (PE). The need for effective VTE prophylaxis in patients unable to receive heparin-based products is underscored by Geerts and colleagues’ prospective study on patients not receiving anticoagulation, where 58% of their 349 trauma patients were found to have a deep venous thrombus [1]. Additionally, previous investigations have demonstrated PE formation can occur within 24 hours of traumatic injury [2,3]. Furthermore, more recent literature underscores the risk of withholding pharmacological anticoagulation in trauma patients, as those who had at-least one missed dose of prophylactic LMWH demonstrated a 23.5% rate of VTE development, compared to 4.8% in those with continuous therapy [4]. Currently, guidelines on the use of rIVCFs are contradictory. The Eastern Association for the Surgery of Trauma practice management’s guideline suggests the use of rIVCFs are advisable in certain patient populations, namely the “very-high- risk trauma patients”. Such patients are defined as the those who cannot receive anticoagulation because of increased bleeding risk or have sustained injuries preventing mobilization such as: i) severe closed head injury (GCS < 8) ii) incomplete spinal cord injury with paraplegia or quadriplegia iii) complex pelvic fracture with associated long bone fractures iv) multiple long bone fractures [5]. Contrasting this, the American College of Chest Physicians stated in their 2012 Guideline on the topic, that there is no role for rIVCFs in primary VTE prevention [6]. Purpose: The risk of venous thromboembolism (VTE) is very high in trauma patients, and VTE prophylaxis by means of pharmacological anticoagulation has become the standard of care in this patient population. Some patients are unable to receive pharmacological VTE prophylaxis and may be high risk for development of VTE. Contemporary use of mechanical prophylaxis with retrievable inferior vena cava filters (rIVCF) among Canadian trauma centers is unknown. The goal of our survey was to better understand current Canadian practices regarding rIVCF for VTE prophylaxis in this challenging patient population. Methods: An online survey based questionnaire was distributed to 16 Canadian Tertiary Care Trauma Center directors. This survey was hosted on the REDCap platform, and was analysed with REDCap software. Results: Response rate was 88%. Fifty percent of our surveyed centres see > 650 severe (ISS >12) trauma patients annually. All responders prefer low molecular weight heparin for VTE prophylaxis over other modalities. When pharmacological anticoagulation contraindicated, a pneumatic compression device was first line in 79%; rIVCF was first line in 21% of centres. Sixty-five percent of responders agree that the risk of rIVCF outweighs its benefit, however, 86% supported the need for future research in the Canadian trauma population, and 64% agree that sufficient clinical equipoise exists to support randomization for a prospective clinical trial. Conclusions: This survey based investigation of Canadian trauma directors has identified notable practice variation regarding rIVCF use for primary prophylaxis and underscores the need for further investigation of their use in high-risk trauma patients. Abstract A national survey of thromboprophylaxis strategies in high risk trauma patients. R Mason Curtis 1* , Kelly Vogt 2 , W Robert Leeper 2,3 , Amol Mujoomdar 4 , Stewart Kribs 4 , Neil Parry 2,3 , Ian Ball 3,5 1 Division of Emergency Medicine, Western University, Ontario, Canada 2 Department of Surgery, Western University, Ontario, Canada 3 Division of Critical Care, Western University, Ontario, Canada 4 Department of Medical Imaging, Western University, Ontario, Canada 5 Department of Epidemiology and Biostatistics, Western University, Ontario, Canada Accepted on January 04, 2018 Keywords: Trauma, Venous thromboembolism, Inferior vena-cava filter, Prophylaxis