Predictors of early resistance to catheter-directed thrombolysis in patients with proximal deep vein thrombosis

Purpose

To determine predictors of immediate thrombolysis resistance (iTR) in patients with proximal deep vein thrombosis (DVT), defined as thrombosis involving the femoral or more proximal veins, with or without concomitant popliteal vein involvement, and to investigate its impact on long-term post-thrombotic syndrome (PTS) outcomes.

Methods

This single-center retrospective study reviewed consecutive patients who underwent catheter-directed thrombolysis (CDT) as first-line therapy. Baseline demographics, clinical history, comorbidities and provoking risk factors for DVT, intraprocedural findings, periprocedural complications, and follow-up outcomes were compared between the iTR and immediate thrombolysis success (iTS) groups.

Results

182 patients (median age, 59.5 years; 53.3 % female) were included, with an iTR incidence of 13.7 % (25/182). After adjusting for body mass index, age (adjusted odds ratio [aOR] 0.95; 95 % confidence interval [CI], 0.92–0.99; p = 0.007), cancer (aOR 9.19; 95 % CI, 2.17–38.86; p = 0.003), urokinase use (aOR 6.69; 95 % CI, 1.78–25.19; p = 0.005), and absence of popliteal venous inflow (aOR 0.15; 95 % CI, 0.04–0.50; p = 0.002) were independent predictors of iTR. The overall complication rate was 10.4 % (19/182), with no significant difference between two groups (p > 0.05). At a median follow-up of 24 months, patients with iTR had a significantly higher incidence of PTS compared to those with iTS (hazard ratio 8.81; 95 % CI: 3.01–25.83; p < 0.001).

Conclusion

CDT is beneficial for the majority of selected patients with proximal DVT and low bleeding risk. Younger age, cancer presence, urokinase use, and absence of popliteal venous inflow were independent predictors of iTR. iTR significantly increased the risk of developing long-term PTS.