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Patients with proximal deep vein thrombosis (DVT) are at high risk for postthrombotic syndrome (PTS), even if they receive systemic anticoagulation therapy. Recently, a small randomized trial showed that catheter-directed thrombolysis (CDT) can prevent PTS (number needed to treat, 7; NEJM JW Gen Med Jan 12 2012), but CDT's effect on mortality and adverse events are unknown. Therefore, clinical practice and guidelines vary (Chest 2012; 141:2 Suppl:e419S; Circulation 2011; 123:1788).
From a national database, researchers identified ≈90,000 patients with principal diagnoses of proximal lower-extremity or caval DVT. The 3600 patients from this cohort who received CDT were compared with a similar number of propensity-matched patients who received…