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Catheter-Directed Thrombolysis Proves Safe in Cancer Patients With Deep Vein Thrombosis: Presented at SIR

By Crina Frincu-Mallos, PhD

WASHINGTON, DC -- March 17, 2008 -- Percutaneous catheter-directed thrombolysis (CDT) is safe for acute symptomatic deep venous thrombosis (DVT) both in cancer patients and in noncancer patients, researchers reported here at the Society of Interventional Radiology (SIR) 33rd Annual Scientific Meeting.

Approximately 15% of cancer patients develop DVT, according to lead author Stephen R. Preece, BA, Interventional Radiology Applicant, Johns Hopkins School of Medicine, Baltimore, Maryland.

Catheter-directed thrombolysis has been shown to result in rapid reduction of thrombus burden and symptoms, and to reduce the risk of recurrence. However, CDT is associated with greater risk of complications, such as major bleeding, than conventional anticoagulation approaches. Therefore, patients with malignancies are not considered to be good candidates for DVT trials, explained Dr. Preece.

Dr. Preece and colleagues therefore conducted a retrospective analysis of 178 consecutive patients with acute iliofemoral or brachiosubclavian DVT to test the efficacy and safety of CDT for patients with or without cancer. The study evaluated a total of 75 limbs in 61 cancer patients and 127 limbs in 117 noncancer patients who were treated with CDT between 1995 and 2007 at Johns Hopkins Hospital.

Patients were divided into 2 groups: those with active cancer -- defined as patients undergoing treatment for cancer (such as radiation, surgery, or chemotherapy) -- at the time of the DVT and those who were free of cancer at DVT, said Dr. Preece in his presentation on March 16.

Gender, clot location, and previous history of DVT were similar between the 2 groups. Patients without cancer were younger than cancer patients (mean 39 vs 55 years, respectively), explained Dr. Preece, and had higher incidence of thrombophilia, defined as any documented biochemical anticoagulant disorder (36% vs 14.7%, respectively)."

During the CTD procedure, subtherapeutic intravenous heparin was used. The mean treatment duration was similar in the 2 groups (28.8 vs 29.7 hours, respectively; P = .7774).

"In terms of [treatment] outcome, the clot reduction was also similar in the 2 groups. Grade 3, or complete clot lysis, was achieved in 66.7% of cancer patients versus 66.4% of patients without cancer," said Dr. Preece.

The researchers also analysed data looking at clot location, iliofemoral versus brachiosubclavian DVT and found no significant difference when the clot locations were correlated with clot lysis rates or complication rates.

Looking at safety, the researchers found that 4.9% of cancer patients versus 3.4% of noncancer patients had major bleeding during CDT. The occurrence of pulmonary embolism was also similar in the 2 groups (1.6% in cancer patients vs 1.7% in noncancer patients; P = .9999).

"There were no intracranial haemorrhages or haemorrhage-related deaths," noted Dr. Preece. Age appears to be a risk factor for complications: patients aged 75 or greater had an increased risk of major bleeding (P = .04).

Dr. Preece and colleagues concluded that CDT presents similar risks and benefits for patients with or without cancer suffering from acute symptomatic DVT. Therefore, this approach should not be avoided by interventional radiologist physicians as a treatment for cancer patients.


[Presentation title: Safety of Catheter-Directed Thrombolysis for Deep Venous Thrombosis in Patients With Cancer. Abstract 1]

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