Safety of catheter-directed thrombolysis for deep venous thrombosis in cancer patients

Background: The current study was conducted to demonstrate that catheter-directed thrombolysis for upper and lower extremity deep vein thrombosis is equally safe in patients with and without cancer. Methods: A retrospective cohort of consecutive patients with acute iliofemoral or brachiosubclavian deep vein thrombosis treated with catheter-directed thrombolysis was identified. Demographic characteristics and clinical outcomes were compared between patients with cancer and without cancer. Results: Catheter-directed thrombolysis was used to treat 202 limbs in 178 patients (75 limbs in 61 cancer patients and 127 limbs in 117 patients without cancer). The mean treatment duration for patients with cancer (29.7 ± 21.2 hours) and without cancer (28.8 ± 22.2 hours) was similar (P = .7774). Catheter-directed thrombolysis achieved grade III clot lysis in a similar proportion of cancer patients (50 of 75 limbs, 66.7%) and patients without cancer (82 of 127 limbs, 64.6%; P = .7619). Grade II clot lysis also was achieved in equal numbers of patients with (20 of 75 limbs, 26.7%) and without cancer (34 of 127 limbs, 26.8%; P = .9872). Three cancer patients (4.9%) and four noncancer patients (3.4%) experienced major bleeding during catheter-directed thrombolysis (P = .6924). Pulmonary embolism occurred in 1.6% (1 of 61) of cancer patients and in 1.7% (2 of 117) of patients without cancer (P = .9999) during catheter-directed thrombolysis. Patients aged ≥70 years had an increased risk of major bleeding. Conclusion: Percutaneous catheter-directed thrombolysis is equally safe for patients with and without cancer who have acute symptomatic deep vein thrombosis.