Study Finds Flaws in New Therapy For Blood Clots

In current many years, catheter-directed thrombolysis (CDT) has been additional to the present common of anticoagulation treatment in some individuals with deep vein thrombosis (DVT). The hope was that CDT would support reduce the large fee of post-thrombotic syndrome (PTS), but now an observational review finds no benefits and some critical disadvantages connected with CDT.

In a report published in JAMA Internal Medicine, Riyaz Bashir and colleagues analyzed data from far more than 90,000 patients hospitalized for DVT, 3649 of whom received CDT plus anticoagulation. In-hospital mortality did not differ substantially in between the CDT sufferers and matched controls who obtained anticoagulation alone (1.two% and .9%, respectively p=.15). Nevertheless, the CDT group had drastically increased charges of pulmonary embolism, intracranial hemorrhage, and vena cava filter placement. The CDT group also had longer and more pricey hospital stays.

The authors acknowledge the limitations of observational studies and call for randomized trials “to evaluate the magnitude of the impact of CDT on outcomes such as mortality, PTS and recurrence of DVT.” They conclude that CDT “should be provided only to patients with a reduced bleeding risk. … it is essential that the magnitude of advantage from CDT be substantial to justify the increased initial resource utilization and bleeding risks of this treatment.”

John Ryan, a cardiologist at the University of Utah, provided this thoughtful perspective on the study:

This is an timely review simply because there has been an boost in CDT use with no an accompanying increase in randomized information. Nonetheless, there are some limitations in this registry that need to be highlighted- in some institutions, short-term IVC filters are positioned as portion of the CDT process, so might not automatically reflect a complication but rather can be part of the protocol. Also, if a patient already has a PE and is mentioned to have residual large burden of DVT, they could be referred for CDT to aid avert one more embolus- this, in component, may possibly account for higher charges of PE in CDT treated individuals. In spite of these issues, this registry examine identifies a lot of troubles with the increasing use of CDT, in distinct the improved chance of intracranial hemorrhage is concerning and may possibly reflect variable doses of thrombolytics. As the authors highlight we need randomized information on CDT to figure out exactly the risks and positive aspects linked with this procedure, as well as standardized approaches and dosages to this method.

Study Finds Flaws in New Therapy For Blood Clots