Lakhter Vladimir, Zack Chad J, Brailovsky Yevgeniy, Chatterjee Saurav, Aggarwal Vikas, Rao Koneti A, Crabbe Deborah, Zhao Huaqing, Choi Eric, Kolluri Raghu, Bashir Riyaz
1 Division of Cardiovascular Medicine, Temple University School of Medicine, Philadelphia, PA, USA.
2 Division of Cardiovascular Sciences, Mayo Clinic, Rochester, MN, USA.
Vasc Med. 2017 Apr;22(2):128-134. doi: 10.1177/1358863X17694091. Epub 2017 Mar 17.
Catheter-directed thrombolysis (CDT) is being increasingly used for the treatment of proximal lower extremity (LE) deep venous thrombosis (DVT). However, sex differences in utilization and safety outcomes of CDT in these patients are unknown. The Nationwide Inpatient Sample (NIS) database was used to identify all patients with a principal discharge diagnosis of proximal LE or caval DVT who underwent CDT between January 2005 and December 2011 in the United States. We evaluated the comparative safety outcomes of CDT among a propensity-matched group of 1731 men versus 1731 women. Among 108,243 patients with proximal LE or caval DVT, 4826 patients (4.5%) underwent CDT. Overall, women underwent CDT less often compared to men (4.1% vs 4.9%, p<0.01, respectively). The rates of CDT increased between 2005 and 2011 for both women (2.1% to 5.9%, p<0.01) and men (2.5% to 7.5%, p<0.01). There was no significant difference in in-hospital mortality (1.2% vs 1.3%, p=0.76). Women were noted to have higher rates of blood transfusions (11.7% vs 8.8%, p<0.01), but lower rates of intracranial hemorrhage (0.5% vs 1.2%, p=0.03) and gastrointestinal bleeding (0.9% vs 2.2%, p<0.01) compared with men. Women were more likely to undergo inferior vena cava filter placement (37.0% vs 32.1%, p<0.01). In this large nationwide cohort, women with proximal DVT were less likely to receive CDT compared to men. Although mortality rates were similar, women were noted to have higher blood transfusion rates while men had more episodes of intracranial and gastrointestinal bleeding.
导管定向溶栓术（CDT）越来越多地用于治疗近端下肢（LE）深静脉血栓形成（DVT）。然而，这些患者在CDT的使用情况和安全性结果方面的性别差异尚不清楚。利用全国住院患者样本（NIS）数据库来识别2005年1月至2011年12月在美国接受CDT治疗且主要出院诊断为近端LE或腔静脉DVT的所有患者。我们评估了1731名男性与1731名女性倾向匹配组中CDT的比较安全性结果。在108243例近端LE或腔静脉DVT患者中，4826例（4.5%）接受了CDT。总体而言，女性接受CDT的频率低于男性（分别为4.1%和4.9%，p<0.01）。2005年至2011年期间，女性（从2.1%至5.9%，p<0.01）和男性（从2.5%至7.5%，p<0.01）的CDT使用率均有所增加。住院死亡率无显著差异（1.2%对1.3%，p=0.76）。与男性相比，女性的输血率较高（11.7%对8.8%，p<0.01），但颅内出血率（0.5%对1.2%，p=0.03）和胃肠道出血率（0.9%对2.2%，p<0.01）较低。女性更有可能接受下腔静脉滤器置入（37.0%对32.1%，p<0.01）。在这个大型全国队列中，与男性相比，患有近端DVT的女性接受CDT的可能性较小。虽然死亡率相似，但女性的输血率较高，而男性的颅内和胃肠道出血发作更多。
