From Department of Medicine (H.J.), Division of Cardiovascular Medicine (V.A., V.L., M.A.A., A.A.D., R.B.), and Department of Clinical Sciences (H.Z.), Temple University School of Medicine, Philadelphia, PA; Division of Cardiovascular Sciences, Mayo Clinic, Rochester, MN (C.J.Z.); and Department of Vascular Surgery, ProMedica Toledo Hospital, OH (A.L.).
Circulation. 2015 Sep 22;132(12):1127-35. doi: 10.1161/CIRCULATIONAHA.115.015555. Epub 2015 Jul 21.
The use of catheter-directed thrombolysis (CDT) in the treatment of acute proximal lower-extremity deep vein thrombosis is increasing in the United States and has been linked to higher bleeding rates. Whether this relationship is interrelated with institution volume of CDT is unknown.
The Nationwide Inpatient Sample database was used to identify all patients admitted with a principal diagnosis of proximal or inferior vena caval deep vein thrombosis and treated with CDT from 2005 to 2010. Institutions were divided into high-volume (≥6 procedures a year) and low-volume (<6 procedures a year) centers. Propensity score matching was used to create 2 matched groups for comparative analysis. A total of 90 618 patients were hospitalized for proximal lower-extremity deep vein thrombosis, and 3649 patients (4.1%) underwent CDT. In-hospital mortality was significantly lower at high-volume centers (0.6% versus 1.5%; P=0.04) with a trend toward lower intracranial hemorrhage rates compared with low-volume centers (0.4% versus 1%; P=0.07). No significant difference was seen with blood transfusion (10.4% versus 10.8%; P=0.70), gastrointestinal bleeding (1.4% versus 1.8%; P=0.35), or pulmonary embolism rates (18.4% versus 17.9%; P=0.72). Median length of stay was similar (6 days) and hospital charges were higher ($65 500 versus $75 870) at high-volume centers.
In this observational study, we found that an increase in institutional volume of CDT was associated with lower in-hospital mortality and lower intracranial hemorrhage rates. Further studies are needed to assess whether standardization of CDT protocols across all institutions in the United States improves outcomes.
在美国，导管定向溶栓（CDT）在治疗急性下肢近端深静脉血栓形成中的应用越来越多，并且与更高的出血率有关。这种关系是否与 CDT 的机构数量有关尚不清楚。
使用全国住院患者样本数据库，确定了 2005 年至 2010 年期间因近端或下腔静脉深静脉血栓形成并接受 CDT 治疗的所有患者。将机构分为高容量（≥6 例/年）和低容量（<6 例/年）中心。采用倾向评分匹配法为比较分析创建了 2 个匹配组。共 90618 例患者因下肢近端深静脉血栓形成住院，其中 3649 例（4.1%）接受 CDT。高容量中心的院内死亡率明显较低（0.6%比 1.5%；P=0.04），与低容量中心相比，颅内出血率也呈下降趋势（0.4%比 1%；P=0.07）。在输血（10.4%比 10.8%；P=0.70）、胃肠道出血（1.4%比 1.8%；P=0.35）或肺栓塞发生率（18.4%比 17.9%；P=0.72）方面无显著差异。中位住院时间相似（6 天），高容量中心的住院费用较高（65500 美元比 75870 美元）。
在这项观察性研究中，我们发现机构 CDT 数量的增加与较低的院内死亡率和较低的颅内出血率相关。需要进一步的研究来评估美国所有机构是否通过标准化 CDT 方案来改善结果。
