Comparing deep vein thrombosis treatments

Utilization of catheter-directed thrombolysis (CDT, where imaging is used to guide treatment to the site of a blood clot in order to dissolve it) has increased in patients with deep vein thrombosis (DVT) and there appeared to be no difference in in-hospital mortality rates for patients treated with CDT compared with anticoagulation alone, although patients treated with CDT had more adverse events.

DVT is a common cause of complication and death after coronary artery disease and stroke. Several small studies have suggested CDT can reduce the incidence of postthrombotic syndrome (PTS), which can impair quality of life for patients because of resulting pain, swelling and ulcerations. But CDT is controversial with conflicting directives on its use because of inconclusive comparative safety outcomes.

The authors 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. They compared patients treated with CDT plus anticoagulation with patients treated with anticoagulation alone.

Of the 90,618 patients hospitalized for DVT, 3,649 (4.1 percent) underwent CDT. The CDT utilization rate increased from 2.3 percent in 2005 to 5.9 percent in 2010. In-hospital mortality was not significantly different between the CDT and anticoagulation groups (1.2 percent vs. 0.9 percent). However, rates for blood transfusion, pulmonary embolism, intracranial hemorrhage and vena cava filter placement were higher among patients treated with CDT. Patients in the CDT group also had longer average lengths of stay (7.2 vs. 5 days) and higher hospital charges ($85,094 vs. $28,164) compared with the anticoagulation group.

"Since our results are based on observational data, our findings could be subject to residual confounding, which further highlights the need for randomized trial evidence to evaluate the magnitude of the effect of CDT on outcomes such as mortality, PTS and recurrence of DVT. In the absence of such data, it may be reasonable to restrict this form of therapy to those patients who have a low bleeding risk and a high risk for PTS, such as patients with iliofemoral DVT."

JAMA Intern Med. Published online July 21, 2014. doi:10.1001/jamainternmed.2014.3415.

Authors made conflict of interest disclosures. This research was funded by the Division of Cardiovascular Diseases, Temple University Hospital. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.