Thrombolysis for DVT: Has the Time Arrived?

What does this article tell us? Mark: This is a retrospective study of the safety of catheter-directed thrombolysis for proximal DVTs in 90,618 patients who were hospitalized between 2002 and 2010 (estimated to be about one-fourth of the cohort hospitalized during those years). Of these patients, 3,649 underwent catheter-directed thrombolysis. Those who received thrombolysis were compared with those who received standard anticoagulation after propensity matching. In terms of outcomes, all of the risk numbers favored not using catheter-directed thrombolysis. The rate of blood transfusion was 11.1% in the thrombolysis group vs. 6.5% in the anticoagulation group (odds ratio [OR] = 1.85; 95% confidence interval [CI], 1.57 to 2.20; P < .001), the rate of pulmonary embolism was 17.9% vs. 11.4% (OR = 1.69; 95% CI, 1.49 to 1.94; P < .001), and the rate of vena cava filter placement was 34.8% vs. 15.6% (OR = 2.89; 95% CI, 2.58 to 3.23; P < .001). Intracranial bleeding, length of hospital stay, and cost were also more favorable with standard treatment.