Predictors of Intracranial Hemorrhage in Patients Treated with Catheter Directed Thrombolysis for Deep Vein Thrombosis

Abstract Background Although acute intracranial hemorrhage (ICH) is a rare complication of catheter directed thrombolysis (CDT), it remains a major concern associated with the use of this therapy. The incidence and clinical predictors of developing ICH in the setting of CDT are not known. Methods The National Inpatient Sample (NIS) database was used to identify all patients with proximal lower extremity (LE) or caval deep vein thrombosis (DVT) between January 2005 and December 2013 in the United States. Multivariate logistic regression was then performed to identify the clinical predictors of ICH among DVT patient treated with anticoagulation (AC) alone and those treated with CDT. Results Among 138,049 patients with proximal LE or caval DVT, 7119 (5.2%) of patients were treated with anticoagulation therapy and CDT. For patients treated with anticoagulation alone, ICH occurred in 0.2%, compared to 0.7% for those undergoing CDT (p 74 years (OR 2.2, 95% CI 1.2 – 4.3, p=0.02), male sex (OR 1.8, 95% CI 1.01 – 3.3, p=0.048). Of those patients treated with anticoagulation alone, risk factors for the development of ICH were history of stroke, hospital teaching status, and age >74 years. Conclusions This nationwide observational study showed that among DVT patients treated with CDT, independent predictors for developing ICH were history of stroke, CKD, male sex, and age >74 years.