Author + information
- Received October 23, 2017
- Revision received April 20, 2018
- Accepted April 24, 2018
- Published online July 16, 2018.
- Othman S. Akhtar, MDa,∗,
- Vladimir Lakhter, DOb,∗,
- Chad J. Zack, MDc,
- Hafiz Hussain, MDd,
- Vikas Aggarwal, MD, MPHb,
- Estefania Oliveros, MDe,
- Yevgeniy Brailovsky, DOf,
- Huaqing Zhao, PhDg,
- Ravi Dhanisetty, MDh,
- Resmi A. Charalel, MDi,
- Matthew Zhaoj and
- Riyaz Bashir, MDb,∗ ()
- aDepartment of Internal Medicine, University of Buffalo, Buffalo, New York
- bDepartment of Cardiovascular Diseases, Temple University Hospital, Philadelphia, Pennsylvania
- cDepartment of Cardiovascular Diseases, Duke University Medical Center, Durham, North Carolina
- dDepartment of Cardiovascular Diseases, New York Presbyterian Queens Hospital, Queens, New York
- eDepartment of Cardiovascular Diseases, Rush University Medical Center, Chicago, Illinois
- fDepartment of Cardiovascular Diseases, Loyola University Medical Center, Maywood, Illinois
- gDepartment of Clinical Sciences, Temple University Hospital, Philadelphia, Pennsylvania
- hDepartment of Vascular Surgery, Temple University Hospital, Philadelphia, Pennsylvania
- iDepartment of Interventional Radiology, Washington University School of Medicine, St. Louis, Missouri
- jDepartment of Chemistry, New York University, New York, New York
- ↵∗Address for correspondence:
Dr. Riyaz Bashir, Temple University Hospital, Division of Cardiovascular Diseases, 3401 North Broad Street (9PP), Philadelphia, Pennsylvania 19140.
Objectives The aim of this study was to investigate the contemporary trends and comparative effectiveness of adjunctive inferior vena cava filter (IVCF) placement in patients undergoing catheter-directed thrombolysis (CDT) for treatment of proximal lower extremity or caval deep vein thrombosis.
Background CDT is being increasingly used in the management of proximal deep vein thrombosis. Although a significant number of patients treated with CDT undergo adjunctive IVCF placement, the benefit of this practice remains unknown.
Methods The National Inpatient Sample database was used to identify all patients with proximal or caval deep vein thrombosis who underwent CDT (with and without adjunctive IVCF placement) in the United States between January 2005 and December 2013. A propensity score–matching algorithm was then used to derive 2 matched groups of patients (IVCF and no IVCF) for comparative outcomes (mortality and major and minor bleeding) and resource use analysis.
Results Of the 7,119 patients treated with CDT, 2,421 (34%) received IVCFs. There was no significant difference in in-hospital mortality (0.7% vs 1.0%; p = 0.20), procedure-related hemorrhage (1.4% vs. 1.0%; p = 0.23), or intracranial hemorrhage (0.7% vs. 0.6%; p = 0.70) between the IVCF (n = 2,259) and no-IVCF (n = 2,259) groups, respectively. Patients undergoing IVCF placement had higher rates of hematoma (3.4% vs 2.1%; p = 0.009), higher in-hospital charges ($104,049 ± 75,572 vs. $92,881 ± 80,194; p < 0.001) and increased length of stay (7.3 ± 5.6 days vs. 6.9 ± 6.9 days; p = 0.046) compared with the no-IVCF group.
Conclusions This nationwide observational study suggests that one-third of all patients undergoing CDT receive IVCFs. IVCF use was not associated with a decrease in in-hospital mortality but was associated with higher inpatient charges and longer length of stay.
↵∗ Drs. Akhtar and Lakhter contributed equally and share coauthorship.
Dr. Bashir is a cofounder and has equity interest in Thrombolex. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 23, 2017.
- Revision received April 20, 2018.
- Accepted April 24, 2018.
- 2018 American College of Cardiology Foundation