{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T13:11:16Z","timestamp":1762866676785},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2015,9,22]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>The use of catheter-directed thrombolysis (CDT) in the treatment of acute proximal lower-extremity deep vein thrombosis is increasing in the United States and has been linked to higher bleeding rates. Whether this relationship is interrelated with institution volume of CDT is unknown.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>\n              The Nationwide Inpatient Sample database was used to identify all patients admitted with a principal diagnosis of proximal or inferior vena caval deep vein thrombosis and treated with CDT from 2005 to 2010. Institutions were divided into high-volume (\u22656 procedures a year) and low-volume (&lt;6 procedures a year) centers. Propensity score matching was used to create 2 matched groups for comparative analysis. A total of 90 618 patients were hospitalized for proximal lower-extremity deep vein thrombosis, and 3649 patients (4.1%) underwent CDT. In-hospital mortality was significantly lower at high-volume centers (0.6% versus 1.5%;\n              <jats:italic>P<\/jats:italic>\n              =0.04) with a trend toward lower intracranial hemorrhage rates compared with low-volume centers (0.4% versus 1%;\n              <jats:italic>P<\/jats:italic>\n              =0.07). No significant difference was seen with blood transfusion (10.4% versus 10.8%;\n              <jats:italic>P<\/jats:italic>\n              =0.70), gastrointestinal bleeding (1.4% versus 1.8%;\n              <jats:italic>P<\/jats:italic>\n              =0.35), or pulmonary embolism rates (18.4% versus 17.9%;\n              <jats:italic>P<\/jats:italic>\n              =0.72). Median length of stay was similar (6 days) and hospital charges were higher ($65 500 versus $75 870) at high-volume centers.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>In this observational study, we found that an increase in institutional volume of CDT was associated with lower in-hospital mortality and lower intracranial hemorrhage rates. Further studies are needed to assess whether standardization of CDT protocols across all institutions in the United States improves outcomes.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circulationaha.115.015555","type":"journal-article","created":{"date-parts":[[2015,7,22]],"date-time":"2015-07-22T02:29:44Z","timestamp":1437532184000},"page":"1127-1135","update-policy":"http:\/\/dx.doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["Impact of Institutional Volume on Outcomes of Catheter Directed Thrombolysis in the Treatment of Acute Proximal Deep Vein Thrombosis"],"prefix":"10.1161","volume":"132","author":[{"given":"Harish","family":"Jarrett","sequence":"first","affiliation":[{"name":"From Department of Medicine (H.J.), Division of Cardiovascular Medicine (V.A., V.L., M.A.A., A.A.D., R.B.), and Department of Clinical Sciences (H.Z.), Temple University School of Medicine, Philadelphia, PA; Division of Cardiovascular Sciences, Mayo Clinic, Rochester, MN (C.J.Z.); and Department of Vascular Surgery, ProMedica Toledo Hospital, OH (A.L.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chad. J.","family":"Zack","sequence":"additional","affiliation":[{"name":"From Department of Medicine (H.J.), Division of Cardiovascular Medicine (V.A., V.L., M.A.A., A.A.D., R.B.), and Department of Clinical Sciences (H.Z.), Temple University School of Medicine, Philadelphia, PA; Division of Cardiovascular Sciences, Mayo Clinic, Rochester, MN (C.J.Z.); and Department of Vascular Surgery, ProMedica Toledo Hospital, OH (A.L.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vikas","family":"Aggarwal","sequence":"additional","affiliation":[{"name":"From Department of Medicine (H.J.), Division of Cardiovascular Medicine (V.A., V.L., M.A.A., A.A.D., R.B.), and Department of Clinical Sciences (H.Z.), Temple University School of Medicine, Philadelphia, PA; Division of Cardiovascular Sciences, Mayo Clinic, Rochester, MN (C.J.Z.); and Department of Vascular Surgery, ProMedica Toledo Hospital, OH (A.L.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vladimir","family":"Lakhter","sequence":"additional","affiliation":[{"name":"From Department of Medicine (H.J.), Division of Cardiovascular Medicine (V.A., V.L., M.A.A., A.A.D., R.B.), and Department of Clinical Sciences (H.Z.), Temple University School of Medicine, Philadelphia, PA; Division of Cardiovascular Sciences, Mayo Clinic, Rochester, MN (C.J.Z.); and Department of Vascular Surgery, ProMedica Toledo Hospital, OH (A.L.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammad A.","family":"Alkhouli","sequence":"additional","affiliation":[{"name":"From Department of Medicine (H.J.), Division of Cardiovascular Medicine (V.A., V.L., M.A.A., A.A.D., R.B.), and Department of Clinical Sciences (H.Z.), Temple University School of Medicine, Philadelphia, PA; Division of Cardiovascular Sciences, Mayo Clinic, Rochester, MN (C.J.Z.); and Department of Vascular Surgery, ProMedica Toledo Hospital, OH (A.L.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huaqing","family":"Zhao","sequence":"additional","affiliation":[{"name":"From Department of Medicine (H.J.), Division of Cardiovascular Medicine (V.A., V.L., M.A.A., A.A.D., R.B.), and Department of Clinical Sciences (H.Z.), Temple University School of Medicine, Philadelphia, PA; Division of Cardiovascular Sciences, Mayo Clinic, Rochester, MN (C.J.Z.); and Department of Vascular Surgery, ProMedica Toledo Hospital, OH (A.L.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony","family":"Comerota","sequence":"additional","affiliation":[{"name":"From Department of Medicine (H.J.), Division of Cardiovascular Medicine (V.A., V.L., M.A.A., A.A.D., R.B.), and Department of Clinical Sciences (H.Z.), Temple University School of Medicine, Philadelphia, PA; Division of Cardiovascular Sciences, Mayo Clinic, Rochester, MN (C.J.Z.); and Department of Vascular Surgery, ProMedica Toledo Hospital, OH (A.L.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alfred A.","family":"Bove","sequence":"additional","affiliation":[{"name":"From Department of Medicine (H.J.), Division of Cardiovascular Medicine (V.A., V.L., M.A.A., A.A.D., R.B.), and Department of Clinical Sciences (H.Z.), Temple University School of Medicine, Philadelphia, PA; Division of Cardiovascular Sciences, Mayo Clinic, Rochester, MN (C.J.Z.); and Department of Vascular Surgery, ProMedica Toledo Hospital, OH (A.L.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Riyaz","family":"Bashir","sequence":"additional","affiliation":[{"name":"From Department of Medicine (H.J.), Division of Cardiovascular Medicine (V.A., V.L., M.A.A., A.A.D., R.B.), and Department of Clinical Sciences (H.Z.), Temple University School of Medicine, Philadelphia, PA; Division of Cardiovascular Sciences, Mayo Clinic, Rochester, MN (C.J.Z.); and Department of Vascular Surgery, ProMedica Toledo Hospital, OH (A.L.)."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1067\/mva.2000.105664"},{"key":"e_1_3_3_3_2","first-page":"S61","article-title":"Quality-of-life improvement using thrombolytic therapy for iliofemoral deep venous thrombosis.","volume":"3","author":"Comerota AJ.","year":"2002","unstructured":"Comerota AJ. 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