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Trends And Outcomes Of Thrombolysis For Deep Venous Thrombosis

Carlos H Timaran, Eric B Rosero, John G Modrall, Rawson J Valentine, George P Clagett.
Univ of Texas Southwestern Med Ctr, Dallas, TX.

OBJECTIVES: Deep venous thrombosis (DVT) is the main cause of pulmonary embolism (PE) and post-thrombotic syndrome (PTS). Although anticoagulation prevents effectively PE and recurrent DVT, it does not avert PTS. Thrombolysis has been used primarily for iliofemoral DVT, improving venous patency and reducing PTS. It is unknown if the increased risk of bleeding secondary to thrombolysis results in increased mortality. The purpose of this study was to evaluate trends and outcomes in the use of thrombolysis nationwide for the treatment of lower extremity DVT.

METHODS: The Nationwide Inpatient Sample (NIS) was used to identify patients discharged with a diagnosis of DVT during the years 1998-2004. Use of thrombolysis and major complications were determined by cross-tabulating discharge diagnostic and procedural codes. Weighted exact Cochrane-Armitage trend test and multivariate logistic regression were used to assess the association between thrombolysis, comorbidities, complications and risk adjusted mortality.

RESULTS: From 1998 to 2003, the total number of cases of DVT increased from 557,727 to 846,222 per year. The incidence of DVT among hospitalized patients significantly increased from 1.57% to 2.17% of discharges (P<.001). The incidence of PE also increased from 0.36% to 0.52% (P<.001). Among patients with a primary diagnosis of DVT, mortality rates raised from 1.07% to 1.22% (P<.001). The overall use of thrombolysis among these patients steadily increased from 0.4% to 2.1 (P<.001). The incidence of major bleeding in patients with DVT also increased over time (0.14% to 1.17%, trend test; P=0.016). Patients receiving thrombolysis had significantly more major bleeding complications (odds ratio [OR], 1.54; 95% confidence interval [CI], 1.4-1.7; P<.001), particularly intracranial hemorrhage (OR, 4.9; 95% CI, 4.1-6.2; P<.001). Overall, adjunctive thrombolysis was associated with increased mortality when adjusting for PE and comorbidities (OR, 1.75; 95 CI, 1.5-2.0: P<.0001).

CONCLUSIONS: The increased use of thrombolysis as an adjunct to anticoagulation for the treatment of DVT has occurred nationwide with an increased risk of major bleeding and mortality. These data should be considered when deciding which patients with DVT need to be treated with thrombolysis.