Catheter-directed thrombolysis did not benefit, may harm patients with DVT

Catheter-directed thrombolysis did not improve mortality compared with anticoagulation in patients with deep vein thrombosis and was associated with increased adverse events, according to new data.

Researchers compared in-hospital outcomes of catheter-directed thrombolysis (CDT) plus anticoagulation with outcomes of anticoagulation alone in an observational study of 90,618 patients with proximal or caval DVT.

According to the study background, prior small studies suggested that CDT could reduce the incidence of post-thrombotic syndrome, which occurs in 20% to 50% of patients with proximal DVT. However, safety outcomes were inconclusive and guidelines on its use differ.

For this study, researchers used the the Nationwide Inpatient Sample database to identify patients with a principal discharge diagnosis of proximal or caval DVT. Using propensity scores, they constructed two matched groups of 3,594 patients each and performed comparative outcomes analysis.

The primary outcome was in-hospital mortality. Secondary outcomes included bleeding complications, length of stay and hospital charges.

In the study population, 4.1% underwent CDT, and utilization rates increased from 2.3% in 2005 to 5.9% in 2010 (P<.001).

When the researchers performed the propensity-matched comparison, there was no difference between the groups in in-hospital morality (CDT group, 1.2%; anticoagulation group, 0.9%; OR=1.4; 95% CI, 0.88-2.25).

However, rates for the following outcomes were higher for the CDT group compared with the anticoagulation group:

·         Blood transfusion: 11.1% vs. 6.5%; OR=1.85; 95% CI, 1.57-2.2.

·         Pulmonary embolism: 17.9% vs. 11.4%; OR=1.69; 95% CI, 1.49-1.94.

·         Intracranial hemorrhage: 0.9% vs. 0.3%; OR=2.72; 95% CI, 1.4-5.3.

·         Vena cava filter placement: 34.8% vs. 15.6%; OR=2.89; 95% CI, 2.58-3.23.

According to the researchers, compared with the anticoagulation group, the CDT group had a longer mean length of stay (7.2 days vs. 5 days; OR=2.27; 95% CI, 1.49-1.94) and higher mean hospital charges ($85,094 vs. $28,164;P<.001).

“[CDT] should be offered only to patients with a low bleeding risk,” Riyaz Bashir, MD, from the division of cardiovascular diseases at Temple University School of Medicine, Philadelphia, and colleagues wrote. “In light of the findings of this study, it is imperative that the magnitude of benefit from CDT be substantial to justify the increased initial resource utilization and bleeding risks of this therapy.”

The researchers noted that these results could be subject to residual confounding, and thus a randomized trial evaluating the effect of CDT on mortality, post-thrombotic syndrome and DVT recurrence is needed.

Disclosure: The study was funded by the division of cardiovascular diseases at Temple University Hospital. One researcher reports receiving research funding from Covidien and another reports having an ownership interest in Insight Telehealth LLC and receiving consulting fees from Health Systems Networks and Insight Telehealth LLC.

Source: www.healio.com