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Underutilization of Thrombolytic Therapy for Patients Diagnosed with Acute Deep Venous Thrombosis in the Outpatient Setting
Mark Archie, MD, Meena Archie, MD, Brian DeRubertis, MD.
University of California, Los Angeles, Los Angeles, CA, USA.
Objective
Catheter-directed thrombolysis has been shown to be a safe and
effective treatment for the management of acute iliofemoral DVT and has been studied in several recent randomized clinical trials. The potential benefits of this therapy include more rapid resolution of symptoms of acute DVT and possible reduction in the long-term sequelae and disability that can result from DVT. Many patients diagnosed with DVT in the inpatient setting have contraindications to lytic therapy, but less is known regarding the suitability of lytic therapy for outpatients diagnosed with acute DVT.
Methods
A manual search of an outpatient vascular laboratory associated with a tertiary medical center was performed to identify all patients referred for the purpose of ruling out DVT between Jan 2013 and December 2014. Vascular lab studies conducted for evaluation of venous insufficiency or vein mapping were excluded. The electronic medical records were then used to determine medical history, imaging, treatment, and any contraindications for thrombolysis.
Results
Over a 2-year period, there were 689 referrals to the outpatient vascular laboratory to for the evaluation of patients with suspected DVT. Of the 689 referrals, 47 (6.8%) were found to have acute and 66 (9%) were found to have chronic DVT. Of the 47 patients with acute DVT, 41 involved the lower extremities and 6 involved the upper extremities. Fifteen of the 41 patients (36%) with extensive acute iliofemoral DVT had no absolute or major contraindications for CDT. Of these 15 patients, only 4 patients were referred to a vascular surgeon and one to the interventional radiology (IR) service. Two patients agreed to and underwent successful CDT.
ConclusionsThough the majority of patients with ALE DVT diagnosed in the outpatient vascular laboratory had contraindications or were not candidates for thrombolysis, less than one third of those who may have benefited from CDT were referred to a vascular specialist for a discussion regarding lytic therapy. Given the potential benefits of CDT and the limited window for optimal results with CDT, it is imperative that patients with acute ileofemoral or extensive femoral DVT be offered an evaluation by a vascular specialist to optimize outcomes following this diagnosis.
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