Study is to how best to treat deep vein thrombosis

Study is to how best to treat deep vein thrombosis -

Patients who have a clot in the legs and considering that to be treated with medication to thin the blood traditional or undergo a minimally invasive catheter-based clot removal procedure should feel comfortable that there is no difference in death rates between the two treatments, although there is more risk bleeding with the catheter procedure, according to a study by the school of medicine researchers at Temple University. The study focused on a review of more than 0,000 cases in the country.

Riyaz Bashir, MD, interventional cardiology specialist and vascular disease in the Temple Heart & Vascular Center, led the study, which aimed to determine the best way to treat a painful condition and potentially fatal called venous thrombosis deep (PST)

The study, to be published by JAMA Internal Medicine , compared two approaches :. catheter-based thrombolysis, which involves inserting a catheter to deliver a thrombolytic drug directly into the leg clot; and medical treatment using medication to thin the blood (anticoagulation). The study found that the mortality rate in hospital was similar for both groups. However, the catheter-based procedure was associated with higher rates of bleeding. The catheter procedure is also more expensive than medical treatment and involved more days in the hospital.

It is estimated that nearly 6 percent of patients with DVT die in the months following diagnosis. The study should help inform an ongoing medical debate on the safest and most effective way to treat deep vein thrombosis, which is the third most common cause of cardiovascular morbidity and death after coronary heart disease and stroke. When a blood clot develops in a vein in the leg, it can break off and travel to the lungs, causing a deadly disease called pulmonary embolism. DVT, which occurs in about 1 in 1,000 people a year, may have a long term effect on the well-being of a person.

Approximately 20 to 50 percent of patients with DVT above the knee will continue to develop a condition called post-thrombotic syndrome (PTS), even when treated with anticoagulation therapy and compression stockings. PTS patients experience pain, swelling, itching, skin discoloration and heaviness in the legs, and, in severe cases, skin ulcers.

"These patients may end very handicapped. They are sometimes unable to work and lose their jobs," said Dr. Bashir, associate professor of medicine. "The post-thrombotic syndrome instead a huge economic burden ($ 2.4 billion and 0 million working days lost each year in the United States) on the health system."

Several studies have shown that the early removal of the clot using a catheter thrombolysis -directed (CDT) led to a significant reduction in the incidence of PTS and improving patient quality of life. the studies were too small, however, to draw conclusions about the safety of catheter-based procedure compared to medical treatment alone using medication to thin the blood, and doctors are divided on which approach is better. the American Heart Association recommends the catheter-based procedure (CDT) as first-line therapy for low risk of bleeding patients, while the American College of Chest Surgeons recommends against the use of CDT due to security problems and the complexity of the procedure.

Dr. Bashir and his research team used a national database called the Nationwide Inpatient Sample to study the outcomes for patients who were hospitalized for DVT between January 05 and December 2010. They identified 0.618 cases general. They then compared 3594 patients who underwent catheter-based procedure to deliver clot-busting drugs in the same number of patients who received anticoagulation alone

Among the findings were the following :.

• The mortality rate at the hospital was not significantly different between the two groups -. 1.2 percent for those who received the catheter procedure, compared to those who received medical therapy alone
• the blood transfusion rate (a measure of bleeding) was 11.1 percent the catheter group against 6. 5 percent for the medical group.
• the rate of pulmonary embolism (clot in the lung) was 17.9 percent against 11.4 percent.
• the rate of intracranial hemorrhage (bleeding in the brain) was 0.9 percent in the catheter group against 0.3 percent for the medical treatment group
• duration hospital stay was longer for patients who had the catheter procedure -. 7 days compared to 5.1 for the other group
• hospital costs were also higher in the catheter group: .. $ 85,553 against $ 29,369

the researchers found that the CDT utilization for the treatment of DVT from 2.3 percent in 05 to 5.9 percent in 2010 over the same period, the mortality rate for patients who took CDT, which is probably a reflection in a refinement in catheter-based technologies and greater experience of the operator. However, the bleeding rate continued to remain higher in this group of patients. The patients who had the procedure in a larger volume center tend to do better, the study found.

Dr. Bashir said some DVT patients clearly benefit from catheter-based procedure, but he said patients had to be carefully selected. His team concluded that more research is needed to sort out the risks and benefits of the procedure.

"In light of the results of this study, it is imperative that the magnitude of the benefit of the CDT must be justified in order to justify the use of increased upstream resources and the risk of bleeding this therapy, "the researchers wrote." without these data, it may be reasonable to limit this form of therapy for patients who have a low bleeding risk and have a high risk of PTS, "such as patients with clots at or above their groins.

"I think all patients with clots in the legs should be informed about the risks of developing PTS and its consequences and risks elimination of catheter-based clot so they can truly participate in shared decision making, "said Dr. Bashir.