DVTs: Clot-Busting Procedure Gaining In Safety and Utilization

Riyaz Bashir MD, FACC, RVT Associate Professor 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

Associate 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 : Blood clots of legs called deep vein thrombosis (DVT) is a very common disease that occurs in about 1.0 person per 1000 population per year. This condition is responsible for more than 600,000 hospitalizations each year in the United States and approximately 6% of these patients will die within 1 month of the diagnosis. Amongst these patients 20% – to 50% will go on to develop chronic leg pains, swelling, heaviness, skin discoloration, and ulcers, in spite of conventional treatment with Blood thinning medications (anticoagulation) and compression stockings.This condition, which is called Post-thrombotic syndrome PTS markedly impairs the quality of life of these patients and is a significant economic burden (2.4 billion dollars and 200 million work days lost annually in US) on the society.In fact, many of these people lose their jobs because of the disability it causes.

Several small studies have shown that early clot removal by minimally invasive catheter-based clot busting procedure called Catheter-directed thrombolysis (CDT) leads to a significant reduction in Post-thrombotic syndrome along with improvements in quality of life. Unfortunately, due to the small number of patients in these studies, we did not have any data about the safety of this treatment option. This has led to conflicting recommendations by various medical societies like the American College of Chest Physicians recommending against its use while the American Heart Association recommends Catheter-directed thrombolysis as first-line treatment for these patients. In light of these conflicting directives, we reviewed the frequency and safety of CDT versus conventional treatment in these patients with blood clots above the knees in the United States using Nationwide Inpatient Sample database from 2005 to 2010.

Medical Research: What are the main findings of the study?
Dr. Bashir :

1.    A very small proportion (4%) of DVT patients in US are treated with minimally invasive catheter-based clot busting procedure (CDT- Catheter directed thrombolysis).

2.    The safety of minimally invasive catheter based thrombus removal (CDT- Catheter directed thrombolysis) has improved over last several years in the United States.

3.    There was no difference in death between CDT versus traditional treatment with blood thinning medications (Anticoagulation), however bleeding risks, length of hospital stay and costs are still higher with CDT.

4.    Results of CDT were markedly better in institutions that were performing more than 5 procedures a year.
Medical Research:Were any of the findings unexpected?
Dr. Bashir :

1.    The study showed that there has been a steady increase in Catheter-directed thrombolysis utilization from 2.3% in 2005 to 5.9% in 2010.

2.    Overall only 4% of these patients in United States are treated with CDT.

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

Dr. Bashir : Both clinicians and patients should feel comfortable that there is no increase in death with Catheter-directed thrombolysis. In the context of these findings, clinicians should offer both treatments options to patients explaining the increased bleeding risks associated with CDT and increased risk of Post Thrombotic Syndrome (PTS) with conventional treatment of anticoagulation alone. We believe this study data should foster “shared decision making” amongst the patients and their treating physician, which is very rarely done at present.

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

Dr. Bashir : Randomized trials looking at the magnitude of reduction of Post-thrombotic syndrome PTS with Catheter-directed thrombolysis and long-term follow-up of these patients to assess the effect of CDT on longer-term death rates and other patient-centered outcomes.

Citation: