Abstract 19358: Comparative Outcomes of Catheter-Directed Thrombolysis plus Anticoagulation versus Anti-Coagulation Alone in the Treatment of Lower Extremity Proximal Deep Vein Thrombosis
Background: The role of catheter-directed thrombolysis (CDT) in treatment of acute proximal deep vein thrombosis (DVT) is controversial and national rates of in-hospital mortality and acute complications in these patients are unknown.
Methods: We used the Nationwide Inpatient Sample (NIS) database from 2005 to 2009 to identify all patients admitted with a principal diagnosis of proximal or caval DVT. In these patients, we evaluated the trends in the utilization rates of CDT and in-hospital outcomes. We compared in-hospital outcomes between the matched groups treated with CDT plus anticoagulation (Group A - 10,730 patients) versus anticoagulation alone (Group B - 10,730). We used propensity scores and Elixhauser comorbidity risk index to match the two treatment groups.
Results: Among a total of 368,974 patients admitted with lower extremity proximal or caval DVT, 3.7% (13,542) underwent CDT. The national CDT utilization rates gradually increased from 2.3% in 2005 to 5.1% in 2009. The groups that were less likely to be treated with thrombolysis included females (3.5% versus 3.9%; p <0.0001), patients greater than 65 years of age (3% versus 6.6%; p < 0.0001), and African Americans (2.9% versus 3.7%; p<0.0001). The outcomes analysis of the matched groups showed that in-hospital mortality was similar in the CDT group than in the anti-coagulation alone group (1.2% versus 0.9%; p= 0.287). In the CDT group, a decline in mortality was noted from 2.0% in 2005 to 0.6% in 2006. The rates of blood transfusion, pulmonary embolism, intracranial bleeding, and vena caval filter placement were significantly higher in the CDT group. The CDT group also had significantly increased length of stay (7±2.3 versus 4.9±1.9 days; P < 0.00001) and hospital charges ($85416 ± 67940 versus $26841 ± 43872; p<0.0001) than the anticoagulation alone group.
Conclusions: In this observational study we found that in-hospital morbidity with catheter-directed thrombolysis remains higher than anticoagulation alone, however recently a significant improvement in in-hospital mortality has been noted.
- © 2012 by American Heart Association, Inc.