Catheter-directed thrombolysis (CDT) has been used in an effort to reduce the incidence of post-thrombotic syndrome in deep vein thrombosis. But a newly published observational study suggests that not only is catheter use ineffective at preventing post-thrombotic syndrome, but it is actually associated with higher rates of adverse events.
The retrospective study published on July 21 in JAMA Internal Medicine examined the records of two matched groups of 3,594 proximal or caval deep vein thrombosis (DVT) patients from 2005 to 2010 in the Nationwide Inpatient Sample database. One group was treated with CDT plus anticoagulants, while the other was treated with anticoagulants alone.
The expectation based on prior small studies was that CDT would reduce the incidence of post-thrombotic syndrome, which occurs in 20% to 50% of patients with proximal DVT. But this study found that CDT did not improve in-hospital mortality, which was not significantly different at 1.2% for CDT and 0.9% for anticoagulants alone.
In addition, the CDT group had significantly higher rates of blood transfusion, pulmonary embolism, intracranial hemorrhage and vena cava filter placement. They also had longer mean hospital stays and higher hospital charges.
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| Covidien's Trellis catheter to treat DVT--Courtesy of Covidien |
The study authors called for a randomized trial to look at mortality and port-thrombotic syndrome endpoints to definitively address the issue of comparative effectiveness for these treatment approaches.
One of the researchers reported funding from Covidien ($COV), which markets catheters to treat DVT.
- here is a detailed article from Helios on the study results
- and the JAMA Internal Medicine article