Pharmacomechanical Catheter-Directed Thrombolysis for Deep-Vein Thrombosis
Open accessAbstract
BACKGROUND: The post-thrombotic syndrome frequently develops in patients with proximal deep-vein thrombosis despite treatment with anticoagulant therapy. Pharmacomechanical catheter-directed thrombolysis (hereafter "pharmacomechanical thrombolysis") rapidly removes thrombus and is hypothesized to reduce the risk of the post-thrombotic syndrome. METHODS: We randomly assigned 692 patients with acute proximal deep-vein thrombosis to receive either anticoagulation alone (control group) or anticoagulation plus pharmacomechanical thrombolysis (catheter-mediated or device-mediated intrathrombus delivery of recombinant tissue plasminogen activator and thrombus aspiration or maceration, with or without stenting). The primary outcome was development of the post-thrombotic syndrome between 6 and 24 months of follow-up. RESULTS: Between 6 and 24 months, there was no significant between-group difference in the percentage of patients with the post-thrombotic syndrome (47% in the pharmacomechanical-thrombolysis group and 48% in the control group; risk ratio, 0.96; 95% confidence interval [CI], 0.82 to 1.11; P=0.56). Pharmacomechanical thrombolysis led to more major bleeding events within 10 days (1.7% vs. 0.3% of patients, P=0.049), but no significant difference in recurrent venous thromboembolism was seen over the 24-month follow-up period (12% in the pharmacomechanical-thrombolysis group and 8% in the control group, P=0.09). Moderate-to-severe post-thrombotic syndrome occurred in 18% of patients in the pharmacomechanical-thrombolysis group versus 24% of those in the control group (risk ratio, 0.73; 95% CI, 0.54 to 0.98; P=0.04). Severity scores for the post-thrombotic syndrome were lower in the pharmacomechanical-thrombolysis group than in the control group at 6, 12, 18, and 24 months of follow-up (P<0.01 for the comparison of the Villalta scores at each time point), but the improvement in quality of life from baseline to 24 months did not differ significantly between the treatment groups. CONCLUSIONS: Among patients with acute proximal deep-vein thrombosis, the addition of pharmacomechanical catheter-directed thrombolysis to anticoagulation did not result in a lower risk of the post-thrombotic syndrome but did result in a higher risk of major bleeding. (Funded by the National Heart, Lung, and Blood Institute and others; ATTRACT ClinicalTrials.gov number, NCT00790335 .).
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In general, thrombolytics for proximal DVT were systemically infused, except in 4 trials where they were catheter directed and 2 trials where they were locoregionally infused.
“In general, thrombolytics were systemically infused, except in 4 trials, including the recently published ATTRACT trial, in which thrombolytics were catheter directed 133,134,146,148 and 2 trials in which thrombolytics were locoregionally infused. 141,142”
From American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism (2020) · cites this paper as [146]
The effect of thrombolytics on PTS was considered precise but was rated down by risk of bias and inconsistency, given that 7 included studies reported significant PTS reduction whereas the ATTRACT trial reported no significant effect (I2=57%).
“The effect on PTS was considered precise, but as before, we rated it down by risk of bias. Additionally, we also rated down the certainty in the evidence by inconsistency, given that 7 of the included studies reported significant PTS reduction, whereas 1 single trial (ATTRACT trial) 146 reported the absence of a significant effect (I 2 5 57%).”
From American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism (2020) · cites this paper as [146]
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Cites
Kearon (2012) · doi:10.1378/chest.11-2301 · Cited by 6,119 · see citing works
Schulman, S., & Kearon, C. (2005) · Journal of Thrombosis and Haemostasis · doi:10.1111/j.1538-7836.2005.01204.x · Cited by 5,025 · see citing works
Self-citationAntithrombotic Therapy for VTE Disease
Kearon, C., Akl, E. A., Ornelas, J., Blaivas, A., Jimenez, D., Bounameaux, H., Huisman, M., King, C. S., Morris, T. A., Sood, N., et al. (2016) · Chest · doi:10.1016/j.chest.2015.11.026 · Cited by 4,830 · see citing works
Self-citationSchulman, S., Angerås, U., Bergqvist, D., ERIKSSON, B., Lassen, M. R., & FISHER, W. (2009) · Journal of Thrombosis and Haemostasis · doi:10.1111/j.1538-7836.2009.03678.x · Cited by 3,761 · see citing works
The Long-Term Clinical Course of Acute Deep Venous Thrombosis
Prandoni, P., Lensing, A. W. A., Cogo, A., Cuppini, S., Villalta, S., Carta, M., Cattelan, A. M., Polistena, P., Bernardi, E., & Prins, M. H. (1996) · Annals of Internal Medicine · doi:10.7326/0003-4819-125-1-199607010-00001 · Cited by 2,094 · see citing works
Enden, T., Haig, Y., Kløw, N.-E., Slagsvold, C.-E., Sandvik, L., Ghanima, W., Hafsahl, G., Holme, P. A., Holmen, L. O., Njaastad, A. M., et al. (2012) · The Lancet · doi:10.1016/s0140-6736(11)61753-4 · Cited by 990 · see citing works
Mewissen, M. W., Seabrook, G. R., Meissner, M. H., Cynamon, J., Labropoulos, N., & Haughton, S. H. (1999) · Radiology · doi:10.1148/radiology.211.1.r99ap4739 · Cited by 901 · see citing works
Brandjes, D. P. M., Buller, H. R., Heijboer, H., Huisman, M. V., de Rijk, M., Jagt, H., & ten Cate, J. W. (1997) · The Lancet · doi:10.1016/s0140-6736(96)12215-7 · Cited by 859 · see citing works
Determinants and Time Course of the Postthrombotic Syndrome after Acute Deep Venous Thrombosis
Kahn, S. R., Shrier, I., Julian, J. A., Ducruet, T., Arsenault, L., Miron, M. ‐., Roussin, A., Desmarais, S., Joyal, F., Kassis, J., et al. (2008) · Annals of Internal Medicine · doi:10.7326/0003-4819-149-10-200811180-00004 · Cited by 850 · see citing works
Self-citationBelow-Knee Elastic Compression Stockings To Prevent the Post-Thrombotic Syndrome
Prandoni, P., Lensing, A. W. A., Prins, M. H., Frulla, M., Marchiori, A., Bernardi, E., Tormene, D., Mosena, L., Pagnan, A., & Girolami, A. (2004) · Annals of Internal Medicine · doi:10.7326/0003-4819-141-4-200408170-00004 · Cited by 653 · see citing works
Vasquez, M. A., Rabe, E., McLafferty, R. B., et al. (2010) · Journal of Vascular Surgery · doi:10.1016/j.jvs.2010.06.161 · Cited by 586 · see citing works
Compression stockings to prevent post-thrombotic syndrome: a randomised placebo-controlled trial
Kahn, S. R., Shapiro, S., Wells, P. S., Rodger, M. A., Kovacs, M. J., Anderson, D. R., Tagalakis, V., Houweling, A. H., Ducruet, T., Holcroft, C., et al. (2013) · The Lancet · doi:10.1016/s0140-6736(13)61902-9 · Cited by 517 · see citing works
Self-citationKahn, S. R., Partsch, H., Vedantham, S., Prandoni, P., & Kearon, C. (2009) · Journal of Thrombosis and Haemostasis · doi:10.1111/j.1538-7836.2009.03294.x · Cited by 515 · see citing works
Self-citationDeterminants of health‐related quality of life during the 2 years following deep vein thrombosis
Kahn, S. R., Shbaklo, H., Lamping, D. L., Holcroft, C., Shrier, I., Miron, M. ‐., Roussin, A., Desmarais, S., Joyal, F., Kassis, J., et al. (2008) · Journal of Thrombosis and Haemostasis · doi:10.1111/j.1538-7836.2008.03002.x · Cited by 500 · see citing works
Self-citationHaig, Y., Enden, T. R., Grøtta, O. J., Kløw, N., Slagsvold, C.-E., Ghanima, W., Sandvik, L., Hafsahl, G., Holme, P. A., Holmen, L. O., et al. (2016) · The Lancet Haematology · doi:10.1016/s2352-3026(15)00248-3 · Cited by 441 · see citing works
Iliofemoral deep venous thrombosis: aggressive therapy with catheter-directed thrombolysis.
Semba, C. P., & Dake, M. D. (1994) · Radiology · doi:10.1148/radiology.191.2.8153327 · Cited by 404 · see citing works
Thrombolysis for acute deep vein thrombosis
Watson, L., Broderick, C., & Armon, M. P. (2016) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd002783.pub4 · Cited by 372 · see citing works
Lamping, D. L., Schroter, S., Kurz, X., Kahn, S. R., & Abenhaim, L. (2003) · Journal of Vascular Surgery · doi:10.1067/mva.2003.152 · Cited by 357 · see citing works
Self-citationVenous Claudication in Iliofemoral Thrombosis
Delis, K. T., Bountouroglou, D., & Mansfield, A. O. (2003) · Annals of Surgery · doi:10.1097/01.sla.0000103067.10695.74 · Cited by 332 · see citing works
van Dongen, C. J. J., Prandoni, P., Frulla, M., Marchiori, A., Prins, M. H., & Hutten, B. A. (2005) · Journal of Thrombosis and Haemostasis · doi:10.1111/j.1538-7836.2005.01333.x · Cited by 315 · see citing works
Elliot, M. S., Immelman, E. J., Jeffery, P. C., Benatar, S. R., Funston, M. R., Smith, J. A., SHEPSTONE, B. J., Ferguson, A. D., Jacobs, P., Walker, W. J., et al. (1979) · British journal of surgery · doi:10.1002/bjs.1800661203 · Cited by 287 · see citing works
Kahn, S. R. (2009) · Journal of Thrombosis and Haemostasis · doi:10.1111/j.1538-7836.2009.03339.x · Cited by 267 · see citing works
Self-citationMarder, V. J., Soulen, R. L., Atichartakarn, V., Budzynski, A. Z., Parulekar, S. G., Kim, J. R., Edward, N., Zahavi, J., & Algazy, K. M. (1977) · PubMed · Cited by 264 · see citing works
AbuRahma, A. F., Perkins, S. E., Wulu, J. T., & Ng, A. H. K. (2001) · Annals of Surgery · doi:10.1097/00000658-200106000-00004 · Cited by 257 · see citing works
Vedantham, S., Thorpe, P. E., Cardella, J. F., Grassi, C. J., Patel, N. H., Ferral, H., Hofmann, L. V., d’Othée, B. J., Antonacci, V. P., Brountzos, Ε., et al. (2006) · Journal of Vascular and Interventional Radiology · doi:10.1097/01.rvi.0000197348.57762.15 · Cited by 235 · see citing works
Self-citationArnesen, H., Høiseth, A. D., & Ly, B. E. (1982) · PubMed · Cited by 214 · see citing works
Streptokinase or Heparin in the Treatment of Deep Vein Thrombosis
Arnesen, H., Høiseth, A. D., & Ly, B. E. (1982) · Acta Medica Scandinavica · doi:10.1111/j.0954-6820.1982.tb01904.x · Cited by 212 · see citing works
(2012) · CHEST Journal · doi:10.1378/chest.141.5.1369b · Cited by 208 · see citing works
Reporting Standards for Endovascular Treatment of Lower Extremity Deep Vein Thrombosis
Vedantham, S., Grassi, C. J., Ferral, H., Patel, N. H., Thorpe, P. E., Antonacci, V. P., d’Othée, B. J., Hofmann, L. V., Cardella, J. F., Kundu, S., et al. (2006) · Journal of Vascular and Interventional Radiology · doi:10.1097/01.rvi.0000197359.26571.c2 · Cited by 192 · see citing works
Self-citationLong-term results of venous thrombectomy combined with a temporary arterio-venous fistula
Plate, G., Akesson, H., Einarsson, E., et al. (1990) · European Journal of Vascular Surgery · doi:10.1016/s0950-821x(05)80788-1 · Cited by 186 · see citing works
Vedantham, S., Goldhaber, S. Z., Kahn, S. R., et al. (2013) · American Heart Journal · doi:10.1016/j.ahj.2013.01.024 · Cited by 180 · see citing works
Self-citationVedantham, S., Sista, A. K., Klein, S. J., Nayak, L., Razavi, M. K., Kalva, S. P., Saad, W. E. A., Dariushnia, S. R., Caplin, D. M., Chao, C. P., et al. (2014) · Journal of Vascular and Interventional Radiology · doi:10.1016/j.jvir.2014.04.019 · Cited by 150 · see citing works
Self-citationBashir, R., Zack, C. J., Zhao, H., Comerota, A. J., & Bové, A. A. (2014) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2014.3415 · Cited by 135 · see citing works
Self-citationPharmacomechanical Thrombolysis and Early Stent Placement for Iliofemoral Deep Vein Thrombosis
Vedantham, S., Vesely, T. M., Sicard, G. A., et al. (2004) · Journal of Vascular and Interventional Radiology · doi:10.1097/01.rvi.0000127894.00553.02 · Cited by 129 · see citing works
Self-citationTissue Plasminogen Activator (rt-PA) vs Heparin in Deep Vein Thrombosis
Turpie, A. G. G., Levine, M. N., Hirsh, J., Ginsberg, J. S., Cruickshank, M., Jay, R. M., & Gent, M. (1990) · CHEST Journal · doi:10.1378/chest.97.4_supplement.172s · Cited by 110 · see citing works
Cynamon, J., Stein, E. G., Dym, R. J., et al. (2006) · Journal of Vascular and Interventional Radiology · doi:10.1097/01.rvi.0000221085.25333.40 · Cited by 94 · see citing works
Clinical and Economic Evaluation of the Trellis-8 Infusion Catheter for Deep Vein Thrombosis
Hilleman, D. E., & Razavi, M. K. (2008) · Journal of Vascular and Interventional Radiology · doi:10.1016/j.jvir.2007.10.027 · Cited by 80 · see citing works
Self-citationRobertson, L., Kesteven, P. J., & McCaslin, J. E. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010956.pub2 · Cited by 79 · see citing works
Relationship between intensity and relief in patients with acute severe pain
Bernstein, S. L., Bijur, P. E., & Gallagher, E. J. (2006) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2005.08.007 · Cited by 51 · see citing works
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- Authors
- Vedantham, S., Goldhaber, S. Z., Julian, J. A., Kahn, S. R., Jaff, M. R., Cohen, D. J., Magnuson, E., Razavi, M. K., Comerota, A. J., Gornik, H. L., Murphy, T. P., Lewis, L., Duncan, J. R., Nieters, P., Derfler, M. C., Filion, M., Gu, C.-S., Kee, S., Schneider, J., Saad, N., Blinder, M., Moll, S., Sacks, D., Lin, J., Rundback, J., Garcia, M., Razdan, R., VanderWoude, E., Marques, V., & Kearon, C.
- Affiliations
- Brigham and Women's Hospital (US)
- University of North Carolina at Chapel Hill (US)
- Holy Name Medical Center (US)
- ORCID
- Vedantham, Suresh
- Goldhaber, Samuel Z.
- Julian, Jim A.
- Kahn, Susan R.
- Jaff, Michael R.
- Cohen, David J.
- Magnuson, Elizabeth
- Razavi, Mahmood K.
- Comerota, Anthony J.
- Gornik, Heather L.
- Murphy, Timothy P.
- Lewis, Lawrence
- Duncan, James R.
- Gu, Chu-Shu
- Schneider, Joseph
- Blinder, Morey
- Moll, Stephan
- Sacks, David
- Lin, Judith
- Rundback, John
- Razdan, Rahul
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2017-12-07
- Volume
- 377
- Issue
- 23
- Pages
- 2240-2252
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC5763501
- OpenAlex
- W2774186378
- Cited by
- 866
- References
- 39
- Citations by year
- 2026: 87 · 2025: 91 · 2024: 102 · 2023: 102 · 2022: 88 · 2021: 109 · 2020: 113 · 2019: 98 · 2018: 69 · 2017: 4
- FWCI
- 82.11
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Digital Commons@Becker (Washington University School of Medicine) (submittedVersion)
- Funders
- National Institutes of Health (UL1TR000448, UL1TR002345)
- National Heart, Lung, and Blood Institute (U54HL112303, U01HL088118, U01HL088476, R01HL066216)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
- Keywords
- pharmacomechanical thrombolysis, deep vein thrombosis, post-thrombotic syndrome, thrombolysis, thrombus aspiration, tissue plasminogen activator, anticoagulation, major bleeding, recurrent venous thromboembolism, quality of life, proximal deep vein thrombosis, Villalta score, stenting
- MeSH terms
- Adult, Anticoagulants, Catheterization, Peripheral, Female, Hemorrhage, Humans, Male, Middle Aged, Tissue Plasminogen Activator, Recombinant Proteins, Risk Factors, Thrombolytic Therapy, Incidence, Venous Thrombosis, Postthrombotic Syndrome, Intention to Treat Analysis
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