Comparative Outcomes of Catheter-Directed Thrombolysis Plus Anticoagulation vs Anticoagulation Alone to Treat Lower-Extremity Proximal Deep Vein Thrombosis

Abstract

The role of catheter-directed thrombolysis (CDT) in the treatment of acute proximal deep vein thrombosis (DVT) is controversial, and the nationwide safety outcomes are unknown.OBJECTIVES The primary objective was to compare in-hospital outcomes of CDT plus anticoagulation with those of anticoagulation alone. The secondary objective was to evaluate the temporal trends in the utilization and outcomes of CDT in the treatment of proximal DVT. DESIGN, SETTING, AND PARTICIPANTSObservational study of patients with a principal discharge diagnosis of proximal or caval DVT from 2005 to 2010 in the Nationwide Inpatient Sample (NIS) database. We compared patients treated with CDT plus anticoagulation with the patients treated with anticoagulation alone. We used propensity scores to construct 2 matched groups of 3594 patients in each group for comparative outcomes analysis. MAIN OUTCOMES AND MEASURESThe primary study outcome was in-hospital mortality. The secondary outcomes included bleeding complications, length of stay, and hospital charges.RESULTS Among a total of 90 618 patients hospitalized for DVT (national estimate of 449 200 hospitalizations), 3649 (4.1%) underwent CDT. The CDT utilization rates increased from 2.3% in 2005 to 5.9% in 2010. Based on the propensity-matched comparison, the in-hospital mortality was not significantly different between the CDT and the anticoagulation groups (1.2% vs 0.9%) (OR, 1.40 [95% CI, 0.88-2.25]) (P = .15). The rates of blood transfusion (11.1% vs 6.5%) (OR, 1.85 [95% CI, 1.57-2.20]) (P < .001), pulmonary embolism (17.9% vs 11.4%) (OR, 1.69 [95% CI, 1.49-1.94]) (P < .001), intracranial hemorrhage (0.9% vs 0.3%) (OR, 2.72 [95% CI, 1.40-5.30]) (P = .03), and vena cava filter placement (34.8% vs 15.6%) (OR, 2.89 [95% CI, 2.58-3.23]) (P < .001) were significantly higher in the CDT group. The CDT group had longer mean (SD) length of stay (7.2 [5.8] vs 5.0 [4.7] days) (OR, 2.27 [95% CI, 1.49-1.94])

Trombolisis mecánica y fármaco-mecánica en el tratamiento de trombosis venosa profunda sin respuesta clínica con tratamiento médico convencional

“…Posteriormente, el desarrollo de la trombolisis dirigida por catéter ha permitido la administración directa de trombolíticos en el sitio de la trombosis a través de acceso percutáneo distante, con menor SPT y mejores resultados comparados con el tratamiento anticoagulante exclusivo 5 . Su mayor limitación es el prolongado tiempo de repermeabilización venosa (tarda 54-55 h promedio) 1,16 , lo que incrementa el riesgo de hemorragias severas (1-11%) e intracraneana hasta 0,2% 17,18 .…”

Safety of Catheter-Directed Thrombolysis for the Treatment of Acute Lower Extremity Deep Vein Thrombosis: A Systematic Review and Meta-Analysis

“…After applying the inclusion and exclusion criteria, 24 articles were considered for our metaanalysis, among which 18 case series articles [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] involving 1538 patients and another 6 were articles [36][37][38][39][40][41] comparing CDT with anticoagulation involving 7619 patients fulfilled the eligibility criteria. The data abstraction process is shown in Fig.…”

“…Eighteen case series articles including 8 prospective [18][19][20]23,24,26,28,31] and 10 retrospective studies [21,22,25,27,29,30,[32][33][34][35] and 6 comparison articles including 3 RCTs [38][39][40] and 3 nonrandomized comparative articles [36,37,41] were all published in peer-reviewed journals. Except for 1 study [30] that did not describe the method of DVT diagnosis, the others confirmed the presence of DVT using Duplex ultrasound or venography.…”

“…Complications. All 6 comparative studies [36][37][38][39][40][41] reported complications posttreatment.…”

Tratamento convencional da trombose venosa profunda proximal: ainda uma boa opção?

“…However, postthrombotic syndrome occurred in 42.9% and 64%, respectively, which is not a very large difference, bearing in mind the risks of bleeding and the costs involved in fibrinolysis. In a study focusing on a more recent technique in which the fibrinolytic agent is administered locally via a catheter, Bashir et al 6 found that in 3,649 patients treated with fibrinolytics hospital stay was 40% longer and hospital costs were three times greater compared with conservative treatment. Additionally, treatment with fibrinolytics was associated with significantly more frequent complications, such as pulmonary embolism, intracranial hemorrhages and hematoma.…”