Background: Catheter directed thrombolysis (CDT) is an evolving modality used as an adjunct to anticoagulation in selected patients with acute iliofemoral deep vein thrombosis (DVT). To date, outcomes have primarily focused on vascular patency but there is a paucity of data pertaining to anticoagulation management and bleeding outcomes.
Aims: To review the anticoagulation, management and incidence of bleeding associated with vascular intervention for acute iliofemoral DVT.
Methods: A single centre, retrospective audit of chart and laboratory databases for all patients that presented with an acute iliofemoral DVT between December 2019 and November 2021. Data pertaining to patient demographics, vascular intervention, anticoagulation and incidence of bleeding were collated and analysed.
Results: A total of 79 patients, median age 42 years (range 14-72), with 52% being female were identified. All patients were treated with therapeutic dalteparin pre-procedure and for 6 weeks post intervention. 75 (94.9%) patients underwent CDT with alteplase 0.01mg/kg/hr for a median of 48 hours. 49 (60.8%) also had venous stenting. 53 (70.7%) developed hypofibrinogenemia (fibrinogen < 1.0 g/L) and 46 (61.3%) received supplemental cryoprecipitate. Major bleeding was observed in 8 patients (10.7%). The average drop in haemoglobin was 20 g/L, there was no associated mortality. 62 (78.4%) patients were switched to a direct oral anticoagulant at 6 weeks. 8 patients underwent repeat intervention with the majority (n=5) performed within one month of initial intervention with no bleeding complications.
Conclusion(s): The risk of major bleeding with CDT is low and not increased by re-intervention. Hypofibrinogenemia is strongly associated with increased risk of bleeding and is a common complication of CDT; therefore justifying the recommendation for regular monitoring and consideration of replacement.
To cite this abstract in AMA style:
White K, creeper K, Black S, Thulasidasan N, Breen K. Peri-operative management of anticoagulation and bleeding in patients undergoing Catheter Directed Thrombolysis for acute iliofemoral Deep Vein Thrombosis [abstract]. https://abstracts.isth.org/abstract/peri-operative-management-of-anticoagulation-and-bleeding-in-patients-undergoing-catheter-directed-thrombolysis-for-acute-iliofemoral-deep-vein-thrombosis/. Accessed October 1, 2023.« Back to ISTH 2022 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/peri-operative-management-of-anticoagulation-and-bleeding-in-patients-undergoing-catheter-directed-thrombolysis-for-acute-iliofemoral-deep-vein-thrombosis/