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Temple-led team: Sex-based differences in utilization & outcomes for CDT in DVT patients

Temple University Health System

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IMAGE: Riyaz Bashir, MD, FACC, RVT, Professor of Medicine at the Lewis Katz School of Medicine at Temple University and Director of Vascular and Endovascular Medicine at Temple University Hospital. view more

Credit: Lewis Katz School of Medicine at Temple University

(Philadelphia, PA) - Deep vein thrombosis (DVT) is a serious condition that occurs when a blood clot forms in a vein, often in the deep veins of the legs, thigh or pelvis. Those clots can break loose, travel to the lungs and block blood flow, causing a pulmonary embolism.

The majority of patients with DVT develop it in their lower extremities and that leads to a painful condition known as post-thrombotic syndrome in approximately half of all patients. Post-thrombotic syndrome is marked by pain, swelling, redness and chronic sores in the affected legs. Patients can also develop DVT in a vein carrying deoxygenated blood to the heart from the lower body or from the head, arms and upper body. This is called caval DVT.

One way to treat DVT is a procedure called catheter-directed thrombolysis (CDT), which allows physicians to place a clot-dissolving agent directly into the clot. CDT has become more commonly used in the United States since research showed it reduced the incidence of post-thrombotic syndrome.

Given this increased utilization, a research team led by Riyaz Bashir, MD, FACC, RVT, Professor of Medicine at the Lewis Katz School of Medicine at Temple University and Director of Vascular and Endovascular Medicine at Temple University Hospital, sought to identify and describe sex-based differences in utilization and safety outcomes of CDT for treatment of DVT in the U.S. In research published online by the journal Vascular Medicine, the team found sex-based differences in both utilization and safety outcomes.

"The data provided some interesting findings," says Dr. Bashir. "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."

The research team used the Nationwide Inpatient Sample database to identify 108,243 patients age 18 years or older with a primary discharge diagnosis of proximal lower extremity or caval DVT between January 2005 and December 2011. Of those patients, 4,826 (4.5%) were treated with CDT.

Among the team's findings:

  • Female patients were less likely to be treated with CDT for DVT.
  • Female patients experienced more bleeding complications requiring blood transfusion.
  • Intracranial hemorrhage, gastrointestinal bleeding and acute kidney injury were more common in male patients.
  • Mortality rates were similar for both men and women treated with CDT.
  • Women treated with CDT were more likely to undergo angioplasty, stenting and adjunctive IVC filter placement.

"Future research should focus on uncovering why these sex-based differences exist," says Dr. Bashir. "The answers to those questions could help shape future treatment guidelines for patients who are suitable candidates for CDT."

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About Temple Health

Temple University Health System (TUHS) is a $1.6 billion academic health system dedicated to providing access to quality patient care and supporting excellence in medical education and research. The Health System consists of Temple University Hospital (TUH), ranked among the "Best Hospitals" in the region by U.S. News & World Report; TUH-Episcopal Campus; TUH-Northeastern Campus; Fox Chase Cancer Center, an NCI-designated comprehensive cancer center; Jeanes Hospital, a community-based hospital offering medical, surgical and emergency services; Temple Transport Team, a ground and air-ambulance company; and Temple Physicians, Inc., a network of community-based specialty and primary-care physician practices. TUHS is affiliated with the Lewis Katz School of Medicine at Temple University.

The Lewis Katz School of Medicine (LKSOM), established in 1901, is one of the nation's leading medical schools. Each year, the School of Medicine educates approximately 840 medical students and 140 graduate students. Based on its level of funding from the National Institutes of Health, the Katz School of Medicine is the second-highest ranked medical school in Philadelphia and the third-highest in the Commonwealth of Pennsylvania. According to U.S. News & World Report, LKSOM is among the top 10 most applied-to medical schools in the nation.

Temple Health refers to the health, education and research activities carried out by the affiliates of Temple University Health System (TUHS) and by the Katz School of Medicine. TUHS neither provides nor controls the provision of health care. All health care is provided by its member organizations or independent health care providers affiliated with TUHS member organizations. Each TUHS member organization is owned and operated pursuant to its governing documents.

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