DVT at inferior vena cava tied to higher mortality vs other sites

The incidence of in-hospital mortality is greater among patients with deep venous thrombosis (DVT) involving the inferior vena cava than those with DVT at other locations, a study has found. Additionally, pelvic vein DVT is not associated with higher mortality or more in-hospital embolism when compared with proximal lower extremity DVT.

Of note, “[t]he incidence of in-hospital pulmonary embolism was considerable with DVT at all sites,” according to the investigators.

This retrospective cohort study sought to determine whether DVT involving the pelvic veins or inferior vena cava was associated with higher in-hospital death or higher prevalence of in-hospital pulmonary embolism than proximal or distal lower extremity DVT. The investigators obtained administrative data from the Nationwide Inpatient Sample 2016–2017.

The International Classification of Diseases-10-Clinical Modification codes were used to identify patients hospitalized with a primary diagnosis of DVT at known locations.

In patients treated only with anticoagulants, in-hospital all-cause mortality was 2.2 percent with DVT involving the inferior vena cava vs 0.8 percent with pelvic vein DVT (p<0.0001), 0.7 percent with proximal DVT (p<0.0001), and 0.2 percent with distal DVT (p<0.0001).

Mortality with anticoagulants was comparable between pelvic vein DVT and proximal lower extremity DVT (0.8 percent vs 0.7 percent; p=0.39). Pelvic vein DVT treated with thrombolytics showed a lower mortality than that treated with anticoagulants (0 percent vs 0.8 percent; p<0.0001).

Furthermore, in-hospital pulmonary embolism occurred in 11–23 percent regardless of the site of DVT.