Internationally Trefilov first played for the Soviet national team at the World Championships and 1991 Canada Cup, the Unified Team at the 1992 Winter Olympics, winning a gold medal, and then the Russian national team at several World Championships, as well as the 1998 Winter Olympics, winning a silver.
Tefilov played several seasons in the was selected in the Soviet Championship League. He was selected in the 12th round of the 1991 NHL Entry Draft, 261st overall, by the Calgary Flames. He started his National Hockey League career in 1993 with the Calgary Flames and he went on to spend time with the Chicago Blackhawks, and Buffalo Sabres. He was one of the goaltenders for the Unified Team that won the gold medal at the 1992 Winter Olympics. He also played for Russia in two Olympic Winter Games. His last club was the DEG Metro Stars of the Deutsche Eishockey Liga in Germany, where he played until 2006.
As a member of the IHL's Detroit Vipers, Trefilov shared the James Norris Memorial Trophy with Kevin Weekes for allowing the fewest goals in the IHL in 1999 and won the Norman R. "Bud" Poile Trophy as the IHL playoff most valuable player in 2000 with the Chicago Wolves. He was also the starting goaltender for the Buffalo Sabres in the last game at Buffalo Memorial Auditorium, on 14 April 1996.

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