Health Day - ONLINE EDITION

Study Casts Doubt on Costly Treatment for Leg Clots

Catheter-directed thrombolysis may carry higher risk of bleeding than conventional treatment, researchers say

  • Print

TUESDAY, July 22, 2014 (HealthDay News) -- Two treatments that break up blood clots deep in the veins of the legs appear no different in terms of death risk. However, one results in a greater risk of bleeding and average hospitalization bills that are three times the cost of the other treatment, a new study finds.

The standard treatment for these clots -- known as deep vein thrombosis (DVT) -- is blood-thinning medications and compression stockings. The other, more expensive treatment delivers medication directly to the clot to dissolve it. This procedure, called catheter-directed thrombolysis, has increased in use in recent years despite inconclusive research as to its safety, the study authors said.

"DVT is a very common disease that occurs in about one in 1,000 people per year," said lead researcher Dr. Riyaz Bashir, an associate professor of medicine at Temple University School of Medicine in Philadelphia.

"This condition is responsible for more than 600,000 hospitalizations each year in the United States, and approximately 6 percent of these patients will die within one month of the diagnosis," he said.

About 20 percent to 50 percent of people with deep vein thrombosis develop a serious complication called post-thrombotic syndrome, despite conventional treatment with blood-thinning medications and compression stockings, Bashir said. The patients experience chronic leg pains, swelling, skin discoloration and ulcers.

"Many of these people lose their jobs because of the disability it causes," Bashir added.

Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, said several small studies have suggested that use of catheter-directed thrombolysis may lead to a decrease in risk for post-thrombotic syndrome.

"However, none of these studies have been definitive," Fonarow said. "Guideline recommendations regarding catheter-delivered thrombolysis are mixed, and use in clinical practice is modest and varies substantially by hospital," he added.

For the new study, published online July 21 in JAMA Internal Medicine, Bashir's team collected data on more than 90,600 patients hospitalized for deep vein thrombosis from 2005 through 2010.

About 4 percent of these patients underwent catheter-directed thrombolysis and also received blood-thinning drugs, the researchers found.

Over the study period, use of the catheter procedure more than doubled -- increasing from a little more than 2 percent in 2005 to nearly 6 percent in 2010, the study authors said.

Catheter-directed thrombolysis is an invasive treatment, and it's a potentially expensive one: $85,094 for the average hospital stay compared to $28,164 for patients given the anti-clotting medication and compression stockings, the researchers said.

Bashir's group found no significant difference in deaths between the treatments -- 1.2 percent for catheter-directed thrombolysis versus 0.9 percent for blood-thinning drugs.

But more complications were seen among patients who had catheter-directed thrombolysis. These included the need for blood transfusions, clots traveling to the lungs and bleeding in the brain. There was also a greater need for so-called vena cava filter placement -- placement of a filter to trap blood clots in the large vein that brings blood to the heart.

Patients who underwent catheter-directed thrombolysis also stayed in the hospital longer than those treated with anti-clotting drugs -- 7.2 days versus 5 days, according to the study.

Doctors should offer both treatment options to patients and explain the increased bleeding risks associated with catheter-directed thrombolysis on the one hand, and the increased risk of post-thrombotic syndrome with conventional treatment, on the other, he said.

"We believe this study data should foster shared decision making among the patients and their treating physician, which is very rarely done at present," Bashir said.

Fonarow said that a "randomized trial" that pits catheter-delivered thrombolysis against standard treatment is needed to see if catheter-delivered thrombolysis is better or not.

"While awaiting further evidence, catheter-delivered thrombolysis may be considered in patients with DVT who are at low risk for bleeding," Fonarow said.

More information

To learn more about deep vein thrombosis, visit the U.S. National Heart, Lung, and Blood Institute.

Fact Check

Fact Check

Have you found an error, or know of something we’ve missed in one of our stories?
Please use the form below and let us know.

* Required
  • Please post the headline of the story or the title of the video with the error.

  • Please post exactly what was wrong with the story.

  • Please indicate your source for the correct information.

  • Yes

    No

  • This will only be used to contact you if we have a question about your submission, it will not be used to identify you or be published.

  • Cancel

Having problems with the form?

Contact Us Directly
  • Print

You can comment on most stories on winnipegfreepress.com. You can also agree or disagree with other comments. All you need to do is be a Winnipeg Free Press print or e-edition subscriber to join the conversation and give your feedback.

You can comment on most stories on winnipegfreepress.com. You can also agree or disagree with other comments. All you need to do is be a Winnipeg Free Press print or e-edition subscriber to join the conversation and give your feedback.

Have Your Say

New to commenting? Check out our Frequently Asked Questions.

Have Your Say

Comments are open to Winnipeg Free Press print or e-edition subscribers only. why?

Have Your Say

Comments are open to Winnipeg Free Press Subscribers only. why?

The Winnipeg Free Press does not necessarily endorse any of the views posted. By submitting your comment, you agree to our Terms and Conditions. These terms were revised effective April 16, 2010.

letters

Make text: Larger | Smaller

LATEST VIDEO

Winnipeg Jets Bogosian-Little-Ladd

View more like this

Photo Store Gallery

  • A monarch butterfly looks for nectar in Mexican sunflowers at Winnipeg's Assiniboine Park Monday afternoon-Monarch butterflys start their annual migration usually in late August with the first sign of frost- Standup photo– August 22, 2011   (JOE BRYKSA / WINNIPEG FREE PRESS)
  • The sun peers through the fog to illuminate a tree covered in hoar frost near Headingley, Manitoba Thursday- Standup photo- February 02, 2012   (JOE BRYKSA / WINNIPEG FREE PRESS)

View More Gallery Photos

Poll

Should the federal government be able to censor how Ottawa is portrayed in the CMHR?

View Results

Ads by Google