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ASSESSING THE PREVALENCE OF THROMBOLYSIS IN DVT MANAGEMENT AND IDENTIFYING THE FACTORS CONTRIBUTING TO ITS UTILIZATION
Charles V. Strom, MD, Justin Lee, MD, Haisar Dao, MD, Julia Tassinari, MD, Rocco Ciocca, MD.
St. Elizabeth's Medical Center, Boston, MA, USA.

Objective: To determine the prevalence of thrombolysis in patients admitted with DVT’s and to elucidate patient and hospital characteristics affecting its utilization.
Methods: A retrospective analysis was conducted using the Nationwide Inpatient Sample (NIS) for the years 2004 through 2008. The database was queried using ICD-9-CM codes for all diagnoses of venous embolism and thrombosis (excluding DVT’s in various organ systems). The number of patients receiving thrombolytics was trended over that period. Searches comparing the anatomic locations of treated DVT’s and medical center characteristics were also performed.
Results: Data from this cohort of patients, representing all discharges from a 20% stratified sample of US hospitals over five years, demonstrate an increasing trend in the diagnosis of proximal leg DVT’s (41.5% to 49.3% of all DVT diagnoses), and a decreasing trend in the rate of distal leg DVT’s (33.3% to 27.5%). Resultant use of thrombolytics over that period increased, from 1.3% of patients in 2004 to 1.9% in 2008 (p<0.001). By location, 3.1% of patients with distal leg DVT’s received thrombolysis, versus 3.5% with DVT’s located elsewhere (p=0.048). More notably, 5.3% of patients with proximal leg DVT’s received thrombolysis, versus 1.9% located elsewhere (p<0.001). By teaching status, 2.5% of patients at teaching hospitals received thrombolysis, compared to 3.6% at nonteaching hospitals (p<0.001). Hospital location had no effect, as 3.4% of patients received thrombolysis at both urban and rural centers (p=0.489). Multivariate analyses compared the likelihood of receiving thrombolysis across five different patient and hospital criteria. Odds ratio of receiving thrombolysis in distal leg DVT’s was 0.88 (p=0.092), but significantly greater for proximal leg DVT’s (OR 2.938, p<0.001). Thrombolysis was less likely to be given at teaching programs (OR 0.702, p=0.001), while more likely at nonteaching institutions (OR 1.427, p=0.001). For reference, thrombolysis in the treatment of pulmonary emboli was also considered (OR 1.798, p<0.001).
Conclusions: We identified a steady increase in the use of thrombolytics for venous embolism and thrombosis. This is best exemplified by the heightened prevalence of thrombolytic utilization in the management of proximal lower extremity DVT’s. Institutional teaching status also appears to play a role, with a significantly greater usage of thrombolysis by nonteaching facilities. Hospital location (urban vs. rural) does not appear to play a role.


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