Comparative outcomes of catheter-directed thrombolysis plus anticoagulation versus anticoagulation alone in the treatment of inferior vena caval thrombosis

Mohamad Alkhouli, Chad J. Zack, Huaqing Zhao, Irfan Shafi, Riyaz Bashir

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background-The contemporary practice patterns and role of catheter-directed thrombolysis (CDT) in the treatment of inferior vena cava thrombosis is unknown. Methods and Results-The Nationwide Inpatient Sample database was used to identify patients with a principal discharge diagnosis of inferior vena cava thrombosis (International Classification of Diseases-Ninth Revision-Clinical Modification, 453.2) from 2005 to 2011. We compared patients treated with CDT plus anticoagulation with patients treated with anticoagulation alone. We used propensity scores to construct 2 matched groups of 563 patients for comparative outcomes analysis. Among 2674 patients admitted with inferior vena cava thrombosis, 718 (26.9%) underwent CDT. The national CDT utilization rates increased from 16.0% in 2005 to 34.7% in 2011 (P<0.001). Based on the propensity-matched comparison, the inhospital mortality was not significantly different between the CDT and the anticoagulation groups (2.0% versus 1.4%; P=0.49). The rates of pulmonary embolism (12.1% versus 7.8%; P=0.02), intracranial hemorrhage (1.6% versus 0.2%; P=0.03), and acute renal failure (13.9% versus 9.4%; P=0.02) were significantly higher in the CDT group. The CDT group had longer length of stay and higher hospital charges compared with the anticoagulation group. Conclusions-There has been a steady increase in the use of CDT in the treatment of patients with inferior vena cava thrombosis in the United States. This observational study showed no significant difference in mortality between CDT versus anticoagulation alone; however, the bleeding events and resource utilization were higher in the CDT group. Adequately powered randomized controlled trials are needed in this area.

Original languageEnglish (US)
Article numbere001882
JournalCirculation: Cardiovascular Interventions
Volume8
Issue number2
DOIs
StatePublished - Feb 1 2015

Fingerprint

Venae Cavae
Thrombosis
Catheters
Inferior Vena Cava
Therapeutics
Hospital Charges
Propensity Score
Intracranial Hemorrhages
International Classification of Diseases
Hospital Mortality
Pulmonary Embolism
Acute Kidney Injury
Observational Studies
Inpatients
Length of Stay
Research Design
Randomized Controlled Trials
Databases
Hemorrhage

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

@article{e839eb492b864373b4c839d991091e9c,
title = "Comparative outcomes of catheter-directed thrombolysis plus anticoagulation versus anticoagulation alone in the treatment of inferior vena caval thrombosis",
abstract = "Background-The contemporary practice patterns and role of catheter-directed thrombolysis (CDT) in the treatment of inferior vena cava thrombosis is unknown. Methods and Results-The Nationwide Inpatient Sample database was used to identify patients with a principal discharge diagnosis of inferior vena cava thrombosis (International Classification of Diseases-Ninth Revision-Clinical Modification, 453.2) from 2005 to 2011. We compared patients treated with CDT plus anticoagulation with patients treated with anticoagulation alone. We used propensity scores to construct 2 matched groups of 563 patients for comparative outcomes analysis. Among 2674 patients admitted with inferior vena cava thrombosis, 718 (26.9{\%}) underwent CDT. The national CDT utilization rates increased from 16.0{\%} in 2005 to 34.7{\%} in 2011 (P<0.001). Based on the propensity-matched comparison, the inhospital mortality was not significantly different between the CDT and the anticoagulation groups (2.0{\%} versus 1.4{\%}; P=0.49). The rates of pulmonary embolism (12.1{\%} versus 7.8{\%}; P=0.02), intracranial hemorrhage (1.6{\%} versus 0.2{\%}; P=0.03), and acute renal failure (13.9{\%} versus 9.4{\%}; P=0.02) were significantly higher in the CDT group. The CDT group had longer length of stay and higher hospital charges compared with the anticoagulation group. Conclusions-There has been a steady increase in the use of CDT in the treatment of patients with inferior vena cava thrombosis in the United States. This observational study showed no significant difference in mortality between CDT versus anticoagulation alone; however, the bleeding events and resource utilization were higher in the CDT group. Adequately powered randomized controlled trials are needed in this area.",
author = "Mohamad Alkhouli and Zack, {Chad J.} and Huaqing Zhao and Irfan Shafi and Riyaz Bashir",
year = "2015",
month = "2",
day = "1",
doi = "10.1161/CIRCINTERVENTIONS.114.001882",
language = "English (US)",
volume = "8",
journal = "Circulation: Cardiovascular Interventions",
issn = "1941-7640",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

Comparative outcomes of catheter-directed thrombolysis plus anticoagulation versus anticoagulation alone in the treatment of inferior vena caval thrombosis. / Alkhouli, Mohamad; Zack, Chad J.; Zhao, Huaqing; Shafi, Irfan; Bashir, Riyaz.

In: Circulation: Cardiovascular Interventions, Vol. 8, No. 2, e001882, 01.02.2015.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Comparative outcomes of catheter-directed thrombolysis plus anticoagulation versus anticoagulation alone in the treatment of inferior vena caval thrombosis

AU - Alkhouli, Mohamad

AU - Zack, Chad J.

AU - Zhao, Huaqing

AU - Shafi, Irfan

AU - Bashir, Riyaz

PY - 2015/2/1

Y1 - 2015/2/1

N2 - Background-The contemporary practice patterns and role of catheter-directed thrombolysis (CDT) in the treatment of inferior vena cava thrombosis is unknown. Methods and Results-The Nationwide Inpatient Sample database was used to identify patients with a principal discharge diagnosis of inferior vena cava thrombosis (International Classification of Diseases-Ninth Revision-Clinical Modification, 453.2) from 2005 to 2011. We compared patients treated with CDT plus anticoagulation with patients treated with anticoagulation alone. We used propensity scores to construct 2 matched groups of 563 patients for comparative outcomes analysis. Among 2674 patients admitted with inferior vena cava thrombosis, 718 (26.9%) underwent CDT. The national CDT utilization rates increased from 16.0% in 2005 to 34.7% in 2011 (P<0.001). Based on the propensity-matched comparison, the inhospital mortality was not significantly different between the CDT and the anticoagulation groups (2.0% versus 1.4%; P=0.49). The rates of pulmonary embolism (12.1% versus 7.8%; P=0.02), intracranial hemorrhage (1.6% versus 0.2%; P=0.03), and acute renal failure (13.9% versus 9.4%; P=0.02) were significantly higher in the CDT group. The CDT group had longer length of stay and higher hospital charges compared with the anticoagulation group. Conclusions-There has been a steady increase in the use of CDT in the treatment of patients with inferior vena cava thrombosis in the United States. This observational study showed no significant difference in mortality between CDT versus anticoagulation alone; however, the bleeding events and resource utilization were higher in the CDT group. Adequately powered randomized controlled trials are needed in this area.

AB - Background-The contemporary practice patterns and role of catheter-directed thrombolysis (CDT) in the treatment of inferior vena cava thrombosis is unknown. Methods and Results-The Nationwide Inpatient Sample database was used to identify patients with a principal discharge diagnosis of inferior vena cava thrombosis (International Classification of Diseases-Ninth Revision-Clinical Modification, 453.2) from 2005 to 2011. We compared patients treated with CDT plus anticoagulation with patients treated with anticoagulation alone. We used propensity scores to construct 2 matched groups of 563 patients for comparative outcomes analysis. Among 2674 patients admitted with inferior vena cava thrombosis, 718 (26.9%) underwent CDT. The national CDT utilization rates increased from 16.0% in 2005 to 34.7% in 2011 (P<0.001). Based on the propensity-matched comparison, the inhospital mortality was not significantly different between the CDT and the anticoagulation groups (2.0% versus 1.4%; P=0.49). The rates of pulmonary embolism (12.1% versus 7.8%; P=0.02), intracranial hemorrhage (1.6% versus 0.2%; P=0.03), and acute renal failure (13.9% versus 9.4%; P=0.02) were significantly higher in the CDT group. The CDT group had longer length of stay and higher hospital charges compared with the anticoagulation group. Conclusions-There has been a steady increase in the use of CDT in the treatment of patients with inferior vena cava thrombosis in the United States. This observational study showed no significant difference in mortality between CDT versus anticoagulation alone; however, the bleeding events and resource utilization were higher in the CDT group. Adequately powered randomized controlled trials are needed in this area.

UR - http://www.scopus.com/inward/record.url?scp=84925878308&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84925878308&partnerID=8YFLogxK

U2 - 10.1161/CIRCINTERVENTIONS.114.001882

DO - 10.1161/CIRCINTERVENTIONS.114.001882

M3 - Article

C2 - 25663321

AN - SCOPUS:84925878308

VL - 8

JO - Circulation: Cardiovascular Interventions

JF - Circulation: Cardiovascular Interventions

SN - 1941-7640

IS - 2

M1 - e001882

ER -