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Thrombus
New research has revealed sex-based differences in utilization and outcomes of catheter-directed thrombolysis (CDT) in patients with deep vein thrombosis (DVT).
The study showed that CDT use was more common in men than women, although use of the procedure increased over time for both sexes.
There were significant between-sex differences in the rates of some bleeding complications and certain in-hospital outcomes, but in-hospital mortality rates were similar between the sexes.
Riyaz Bashir, MD, of Temple University in Philadelphia, Pennsylvania, and his colleagues reported these findings in Vascular Medicine.
“The data provided some interesting findings,” Dr Bashir said. “In addition to differences in utilization, we were able to find variations in the incidence of a number of complications, including bleeding that requires blood transfusion, intracranial hemorrhage, gastrointestinal bleeding, and acute kidney injury, as well as the incidence of angioplasty, stenting, and adjunctive IVC filter placement.”
For this study, Dr Bashir and his colleagues analyzed data from the Nationwide Inpatient Sample database.
The team identified 108,243 patients age 18 or older with a primary discharge diagnosis of proximal lower extremity or caval DVT between January 2005 and December 2011. Of those patients, 4826 (4.5%) were treated with CDT.
The researchers found that women underwent CDT less often than men—4.1% and 4.9%, respectively (P<0.01).
But the rates of CDT use increased between 2005 and 2011 for both sexes—from 2.1% to 5.9% in women (P<0.01) and from 2.5% to 7.5% (P<0.01) in men.
The rate of in-hospital mortality was similar between women (1.2%) and men (1.3%, P=0.76).
Likewise, there was no significant between-sex difference in length of hospital stay or total hospital charges. The average length of stay was 7.0 ± 5.7 days for men and 7.1 ± 5.5 days for women (P=0.55).
Average total hospital charges were $88,837 ± 68,284 for men and $91,487 ± 77,129 for women (P=0.28).
Women were more likely than men to:
- Require blood transfusions—11.7% and 8.8%, respectively, (P<0.01)
- Undergo angioplasty—64.1% and 54.3%, respectively (P<0.01)
- Undergo stenting—32.2% and 19.9%, respectively (P<0.01)
- Receive an inferior vena cava filter—37.0% and 32.1%, respectively (P<0.01).
Men were more likely than women to:
- Experience acute kidney injury—9.9% and 6.5%, respectively (P<0.01)
- Have an intracranial hemorrhage (ICH)—1.2% and 0.5%, respectively (P=0.03)
- Experience gastrointestinal bleeding—2.2% and 0.9%, respectively (P<0.01).
The researchers noted that the higher rate of ICH among men overall was due to a higher incidence of ICH among men over the age of 75.
There was no significant difference between men and women when it came to procedure-related hemorrhage—1.4% and 1.2%, respectively (P=0.45).
“Future research should focus on uncovering why these sex-based differences exist,” Dr Bashir said. “The answers to those questions could help shape future treatment guidelines for patients who are suitable candidates for CDT.”
