Photo courtesy of the CDC
New research indicates that a higher institutional case volume is associated with lower in-hospital mortality in patients with lower extremity deep vein thrombosis (LE-DVT) who undergo catheter-directed thrombolysis (CDT).
However, a hospital’s CDT case volume did not have a significant impact on other outcomes, such as bleeding events, the incidence of pulmonary embolism, or the need for blood transfusion.
Researchers reported these findings in Circulation.
The team noted that patients who have LE-DVT are increasingly undergoing CDT rather than receiving anticoagulation alone. Recent studies have shown reductions in lifestyle-limiting complications, such as post-thrombotic syndrome, in patients who undergo CDT. However, data have also shown CDT to be associated with an increased risk of bleeding complications.
So Riyaz Bashir, MD, of Temple University Health System in Philadelphia, Pennsylvania, led a study aimed at determining whether the increase in bleeding complications was correlated with the volume of CDT procedures performed at a particular institution.
Dr Bashir and his colleagues used the Nationwide Inpatient Sample database to identify 90,618 patients admitted to US hospitals with an LE-DVT diagnosis from 2005 to 2010.
The researchers further narrowed that group down to 3649 patients treated with CDT. The team then divided the hospitals into 2 groups: high-volume centers, which performed 6 or more CDT procedures per year, and low-volume centers, which performed less than 6 CDT procedures per year.
In-hospital mortality in patients treated with CDT was significantly lower at high-volume centers than low-volume centers—0.6% and 1.5%, respectively (P=0.04).
The rate of intracranial hemorrhage for high-volume centers was less than half that of low-volume centers, but this difference was not statistically significant—0.4% and 1.0%, respectively (P=0.07).
Likewise, there was no significant difference between high-volume centers and low-volume centers with regard to the rate of blood transfusion (10.4% vs 10.8%, P=0.70), gastrointestinal bleeding (1.4% vs 1.8%, P=0.35), or pulmonary embolism (18.4% vs 17.9% P=0.72).
The median length of hospital stay was 6 days in both groups. But hospital charges were higher at high-volume centers than low-volume centers—$75,870 and $65,500, respectively.
“These findings have potentially major future implications for the treatment of deep vein thrombosis,” Dr Bashir said. “For the first time, we have shown a significant inverse relationship between the institutional CDT volumes and adverse outcomes like death . . . .”
“This does not mean that low-volume centers should not perform CDT for patients with LE-DVT. It means that we should focus on standardizing CDT protocols that include careful patient selection as well as peri-procedural patient monitoring. In addition, establishment of centers of excellence in treating venous thromboembolic disease may provide the necessary framework within which bleeding risk to the patient can be minimized.”
Dr Bashir added that patients with LE-DVT, especially young patients, should feel comfortable considering CDT, particularly at a high-volume center, as a viable option to prevent post-thrombotic syndrome.
“Our overall goal is to treat these DVT patients early on and prevent post-thrombotic syndrome and its adverse consequences on the quality of life,” he said. “We feel this research provides more clarity and direction in identifying the best strategies for how to achieve that goal.”
