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In-hospital outcomes of catheter-directed thrombolysis versus anticoagulation in cancer patients with proximal deep venous thrombosis.
- Source :
-
Journal of vascular surgery. Venous and lymphatic disorders [J Vasc Surg Venous Lymphat Disord] 2020 Jul; Vol. 8 (4), pp. 538-544.e3. Date of Electronic Publication: 2019 Dec 14. - Publication Year :
- 2020
-
Abstract
- Objective: The objective of this study was to determine the rate of complications of catheter-directed thrombolysis (CDT) in cancer patients with deep venous thrombosis (DVT) compared with anticoagulation therapy alone.<br />Methods: This observational study used the National Inpatient Sample database to screen for any cancer patients who were admitted with a principal discharge diagnosis of proximal lower extremity or caval DVT between January 2005 and December 2013. Patients treated with CDT plus anticoagulation were compared with those treated with anticoagulation alone using propensity score matching for comorbidities and demographic characteristics. The primary end point was in-hospital mortality. Secondary end points were acute intracranial hemorrhage, inferior vena cava filter placement, acute renal failure, blood transfusion rates, length of stay, and hospital charges.<br />Results: We identified 31,124 cancer patients with lower extremity proximal or caval DVT, and 1290 (4%) patients were treated with CDT. Comparative outcomes as assessed in the two matched groups of 1297 patients showed that there was no significant difference in in-hospital mortality of patients undergoing CDT plus anticoagulation compared with those treated with anticoagulation alone (2.6% vs 1.9%; P = .23). However, CDT was associated with increased risk of intracranial hemorrhage (1.3% vs 0.4%; P = .017), greater blood transfusion rates (18.6% vs 13.1 %; P < .001), and higher rates of procedure-related hematoma (2.4% vs 0.4%; P < .001). The length of stay (6.0 [4.0-10.0] days vs 4.0 [2.0-7.0] days; P < .001) and hospital charges ($81,535 [$50,968-$127,045] vs $22,320 [$11,482-$41,005]; P < .001) were also higher in the CDT group compared with the control group.<br />Conclusions: There was no significant difference in in-hospital mortality of cancer patients who underwent CDT plus anticoagulation compared with anticoagulation alone. CDT was associated with increased in-hospital morbidity and resource utilization compared with anticoagulation alone. Further studies are needed to examine the effect of CDT on the development of PTS in this population.<br /> (Copyright © 2019 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Anticoagulants adverse effects
Anticoagulants economics
Cost-Benefit Analysis
Databases, Factual
Drug Costs
Female
Fibrinolytic Agents adverse effects
Fibrinolytic Agents economics
Hospital Charges
Hospital Mortality
Humans
Inpatients
Length of Stay
Male
Middle Aged
Neoplasms economics
Neoplasms mortality
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
United States
Venous Thrombosis economics
Venous Thrombosis etiology
Venous Thrombosis mortality
Anticoagulants administration & dosage
Blood Coagulation drug effects
Fibrinolytic Agents administration & dosage
Neoplasms complications
Thrombolytic Therapy adverse effects
Thrombolytic Therapy economics
Thrombolytic Therapy mortality
Venous Thrombosis therapy
Subjects
Details
- Language :
- English
- ISSN :
- 2213-3348
- Volume :
- 8
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Journal of vascular surgery. Venous and lymphatic disorders
- Publication Type :
- Academic Journal
- Accession number :
- 31843480
- Full Text :
- https://doi.org/10.1016/j.jvsv.2019.10.014