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Catheter Directed Thrombolysis for Deep Vein Thrombosis Increases Stroke Risk and Mortality in the Nationwide Inpatient Sample
Thomas Curran, MD, Dominique Buck, MD, John C. McCallum, MD, Jeremy Darling, BA, Raul Guzman, MD, Mark Wyers, MD, Allen Hamdan, MD, Elliot Chaikof, MD, PhD, Marc Schermerhorn, MD.
Beth Israel Deaconess Medical Center, Boston, MA, USA.

OBJECTIVES:
Catheter directed thrombolysis (CDT) may limit long-term morbidity after acute deep vein thrombosis (DVT) but is also associated with complications. As prior studies of CDT have been limited by small sample size and low adverse event rates, we aim to characterize the utilization and short-term risks of CDT for acute DVT in a large national registry.
METHODS:
The Nationwide Inpatient Sample (NIS) was used to capture all inpatient admissions with a primary diagnosis of DVT from 2005 to 2011 using International Classification of Disease Ninth Revision (ICD-9) diagnosis codes. Treatment with CDT was noted via ICD-9 procedure code. CDT and non-CDT groups were compared for development of cerebral hemorrhage, hemorrhage and death. Comparisons were carried out using Fisher’s exact test, t-test or multivariable logistic regression.
RESULTS:
We identified 920,033 patients admitted for DVT with 27,895 (3.0%) receiving CDT. Utilization of CDT increased from 1.4% in 2005 to 4.6% in 2011 (p<.001). CDT patients were younger and less likely to have major medical comorbidities (Table). CDT was associated with increased hemorrhagic stroke (.7% vs. .1%; p<.001), hemorrhage (4% vs. .6%; p<.001) and death (1.2% vs. 0.8%; p<.001). Length of stay was also significantly longer in patients with CDT (6.8 vs. 4.9 days; p<.001). IVC filter placement was more common in CDT patients (34.8% vs. 15.1%; p<.001). Independent predictors of cerebral hemorrhage were CDT [OR: 6.2 (95%CI: 3.5-11.0)] and transfer from long term care facility [OR: 5.5 (95%CI: 2.7-11.8)]. Adjusted for age and comorbidity CDT was associated with an increased risk of death [OR: 1.8 (95%CI: 1.5-2.4)].
CONCLUSIONS:
Though utilization of CDT for the treatment of DVT has risen three-fold since 2005, CDT is associated with a six-fold increase in hemorrhagic stroke risk and two-fold increase in mortality risk. While CDT may decrease late sequellae of DVT, these small but significant short-term risks must be recognized. Further study is required to elucidate the long-term benefit of CDT.
All Patients
(N=920,033)
CDT Patients
(N=27,895)
Non-CDT Patients
(N=892,138)
p value
Age, Mean (Years)64.753.364.5<.001
Female (%)53.548.953.7<.001
Black Race (%)14.911.015.1<.001
Congestive Heart Failure (%)8.63.68.7<.001
Diabetes (%)21.115.221.3<.001
Chronic Obstructive Pulmonary Disease (%)11.27.011.3<.001
Chronic Renal Failure (%)9.76.59.8<.001


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