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Published on: February 10, 2023
Underutilization of Thrombolytic Therapy for Patients Diagnosed with Acute Deep Venous Thrombosis in the Outpatient
Mark Archie1, Meena Archie1, Jessica O'Connell2
1Division of Vascular Surgery, Department of Surgery, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.
Insights
Catheter-directed thrombolysis (CDT) is effective for acute iliofemoral deep venous thrombosis (DVT). However, only a third of eligible outpatient DVT patients were referred for CDT evaluation, highlighting a gap in care. Further research is needed to improve access to this treatment.
Area of Science:
- Vascular Medicine
- Interventional Radiology
- Cardiovascular Surgery
Background:
- Catheter-directed thrombolysis (CDT) is a safe and effective treatment for acute iliofemoral deep venous thrombosis (DVT).
- CDT offers potential benefits like rapid symptom resolution and reduced long-term complications.
- Suitability of CDT for outpatients with acute DVT remains less understood compared to inpatients.
Purpose of the Study:
- To determine the proportion of outpatient DVT patients suitable for thrombolytic therapy.
- To assess the rate of referral to vascular specialists for thrombolysis evaluation in this patient group.
Main Methods:
- Manual search of an outpatient vascular laboratory database (January 2013 - December 2014).
- Identification of patients referred for DVT evaluation, excluding those for venous insufficiency.
- Electronic medical record review to identify contraindications for thrombolysis.
Main Results:
- Out of 689 referrals, 47 patients (6.8%) had acute DVT, with 41 involving lower extremities.
- Fifteen of these 41 patients (37%) with extensive iliofemoral DVT had no contraindications for CDT.
- Only 33% of eligible patients were referred to a vascular specialist; 13% underwent successful CDT.
Conclusions:
- A significant minority of outpatients with acute lower extremity DVT are candidates for CDT.
- Referral rates to vascular specialists for CDT evaluation are suboptimal.
- Ensuring evaluation by a vascular specialist is crucial for optimizing outcomes in eligible DVT patients.
Background:
Catheter-directed thrombolysis (CDT) has been shown to be a safe and effective treatment for the management of acute iliofemoral deep venous thrombosis (DVT). The potential benefits of this therapy include more rapid resolution of symptoms and possible reduction in the long-term sequelae. Many patients diagnosed with DVT in the inpatient setting have contraindications to lytic therapy, but less is known regarding the suitability of thrombolysis for outpatients diagnosed with acute DVT. We sought to determine the proportion of patients who were candidates for thrombolytic therapy and referred to a vascular specialist for evaluation.
Methods:
A manual search of an outpatient vascular laboratory associated with a tertiary medical center was performed to identify all patients referred for the purpose of ruling out DVT between January 2013 and December 2014. Vascular laboratory studies conducted for evaluation of venous insufficiency were excluded. The electronic medical records were reviewed to evaluate for contraindications for thrombolysis.
Results:
Over a 2-year period, there were 689 referrals to the outpatient vascular laboratory for the evaluation of patients with suspected DVT. Of the 689 referrals, 47 (6.8%) were found to have acute DVT, and 66 (9%) were found to have chronic DVT. Of the 47 patients with acute DVT, 41 involved the lower extremities. Fifteen of the 41 patients (37%) with extensive acute iliofemoral DVT had no absolute or major contraindications for CDT. Of these 15 patients, only 33% were referred to a vascular specialist (4 to vascular surgery and 1 to IR). Two patients (13%) agreed to and underwent successful CDT.
Conclusions:
Although the majority of patients with acute lower extremity DVT diagnosed in the outpatient vascular laboratory were not candidates for thrombolysis, one-third of those who may have benefited from CDT were referred to a vascular specialist to discuss lytic therapy. Given the potential benefits of CDT, it is imperative that patients with acute iliofemoral or extensive femoral DVT be offered an evaluation by a vascular specialist to optimize outcomes after this diagnosis.
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