Credit: CDC
New research indicates that anticoagulant therapy alone may be safer than catheter-directed thrombolysis (CDT) for treating deep vein thrombosis (DVT).
The study revealed similar rates of in-hospital mortality among patients treated with CDT and those receiving anticoagulation alone.
However, patients who received CDT were more likely to develop pulmonary emboli, experience intracranial hemorrhaging, and require blood transfusions.
Several previous studies have suggested that CDT can reduce the incidence of post-thrombotic syndrome in DVT patients. But CDT is controversial, with conflicting directives on its use because of inconclusive comparative safety outcomes.
So Riyaz Bashir, MD, of Temple University School of Medicine in Philadelphia, Pennsylvania, and his colleagues set out to compare CDT with anticoagulation alone.
They reported their findings in JAMA Internal Medicine.
The researchers examined in-hospital mortality, as well as secondary outcomes of bleeding complications, length of stay, and hospital charges, in a group of 90,618 patients hospitalized for DVT from 2005 through 2010 as part of the Nationwide Inpatient Sample database.
In all, 3649 patients (4.1%) underwent CDT. The CDT utilization rate increased from 2.3% in 2005 to 5.9% in 2010.
The in-hospital mortality rates were not significantly different in the CDT and anticoagulation-only groups, at 1.2% and 0.9%, respectively (P=0.15).
However, rates of adverse events were higher among patients treated with CDT. This included blood transfusion (11.1% vs 6.5%, P<0.001), pulmonary embolism (17.9% vs 11.4%, P<0.001), intracranial hemorrhage (0.9% vs 0.3%, P=0.03), and vena cava filter placement (34.8% vs 15.6%, P<0.001).
Patients in the CDT group also had longer average lengths of stay (7.2 vs 5 days, P<0.001) and higher hospital charges ($85,094 vs $28,164, P<0.001) compared with the anticoagulation-only group.
The researchers pointed out that their results are based on observational data, so the findings could be subject to residual confounding. Therefore, randomized trials are needed to better evaluate the effects of CDT.
However, the team also said that, as we don’t yet have this information, it may be reasonable to restrict CDT use to those patients who have a low bleeding risk and a high risk for post-thrombotic syndrome.
