DVT: Clot Removal Outcomes Better In Hospitals With Higher Volume of Procedures

Riyaz Bashir MD, FACC, RVTProfessor of Medicine Director, Vascular and Endovascular Medicine Department of Medicine Division of Cardiovascular Diseases Temple University Hospital Philadelphia, PA 19140MedicalResearch.com Interview with:
Riyaz Bashir MD, FACC, RVT
Professor of Medicine
Director, Vascular and Endovascular Medicine
Department of Medicine
Division of Cardiovascular Diseases
Temple University Hospital
Philadelphia, PA 19140

Medical Research: What is the background for this study?

Dr. Bashir: Catheter-based thrombus removal also known as Catheter Directed Thrombolysis (CDT) is a minimally invasive therapeutic intervention that has evolved over the past two decades to reduce the incidence of post thrombotic syndrome (PTS), a very frequent and disabling complication of proximal deep vein thrombosis (DVT). Catheter-based thrombus removal has been shown to reduce this lifestyle limiting complication of DVT and as a result we have observed a significant increase in the utilization rates of CDT across United States. Recent nationwide observational data suggests that higher adverse events such as intracranial hemorrhage rates and need for blood transfusions are seen with CDT use. Nonetheless specific reasons for these findings have not been explored prior to this study. Thread veins, also known as spider veins, are small veins which can appear on your face, thighs or calves and are an issue that many patients want help with. However, they are a cosmetic issue rather than a medical problem. People who suffer from the spider veins often feel that they affect their appearance and confidence and question why do we get thread veins?

Medical Research: What are the main findings?

Dr. Bashir: This study showed a significant inverse relationship between the institutional Catheter-based thrombus removal volumes and safety outcomes like death and intracranial hemorrhage. The institutions with higher volume of CDT cases annually (greater than or equal to 6 cases) were associated with lower in-hospital mortality rates and lower intracranial hemorrhage rates as compared to institutions, which performed less than 6 cases annually. This study also showed that at high volume institutions there was no difference in terms of death or intracranial bleeding rates between CDT plus anticoagulation versus anticoagulation alone.

Medical Research: What should clinicians and patients take away from your report?

Dr. Bashir: These findings highlight the importance of standardization of Catheter-based thrombus removal practice and bring into focus the factors that may decrease adverse bleeding complications. Our observation that the major safety outcomes (death and intracranial hemorrhage) were not significantly different between patients undergoing CDT as compared to patients undergoing anticoagulation therapy alone at high volume centers suggests that these complications can be minimized. Patients with leg DVT – especially young patients – should feel comfortable considering clot removal, particularly at a high volume center, as a viable option to prevent post thrombotic syndrome.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Bashir: As utilization of Catheter-based thrombus removal continues to increase we propose that institutions follow a standardized CDT protocols that include careful patient selection as well as patient monitoring. In addition, establishment of centers of excellence in treating venous thromboembolic disease may provide the necessary framework within which bleeding risk to the patient can be minimized. We also need to monitor these outcomes at institutional and regional levels on an ongoing basis for quality improvement purposes.

Citation:

Impact of Institutional Volume on Outcomes of Catheter Directed Thrombolysis in the Treatment of Acute Proximal Deep Vein Thrombosis: A 6-Year United States Experience (2005-2010)

Harish Jarrett, Chad J. Zack, Vikas Aggarwal, Vladimir Lakhter, Mohammad A. Alkhouli, Huaqing Zhao, Anthony Comerota, Alfred A. Bove, and Riyaz Bashir

Circulation. 2015;CIRCULATIONAHA.115.015555published online before print July 21 2015, doi:10.1161/CIRCULATIONAHA.115.015555

Riyaz Bashir MD, FACC, RVT (2015). DVT: Clot Removal Outcomes Better In Hospitals With Higher Volume of Procedures

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