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Preventing postthrombotic syndrome: CAVENT supports the "open vein hypothesis"

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Posted Feb 10, 2012 at 09:20 AM, EDT by Samuel Goldhaber

CAVENT, a recently published Norwegian study, showed a statistically significant decrease in rates of postthrombotic syndrome two years post-DVT event among patients who underwent catheter-based thrombolysis compared with those treated with a standard regimen of anticoagulation. Will the ATTRACT study—which is currently enrolling—give further credence to the longstanding "open-vein hypothesis"?

See also:

Enden T, Haig Y, Klow N, et al. Long-term outcomes after additional catheter-directed thrombolysis versus standard treatment for acute iliofemeral deep vein thrombosis (the CaVenT study): a randomised controlled trial. Lancet 2011; 379:31-38. Abstract.

Catheter-directed thrombolysis in iliofemoral DVT reduces risk of postthrombotic syndrome

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Dear Dr. Goldhaber,

I am very encouraged to hear the results of the Cavent study.  I believe my brother (currently in the hospital in Baltimore, MD with DVT) may be an excellent candidate for the ATTRACT study. He will be released tomorrow and his INR levels appear to be stabilizing, but there is no plan to perform any open vein procedure to remove the extensive clots which are currently present in both legs.  Although he was hospitalized with quite a bit of initial pain, that has diminished with the administration of low molecular weigh anticoagulants (not heparin to which he reacted) and with adjustment to his coumadin dose levels.  He is 43 and, aside from the current DVT has been relatively healthy since recovering from his stroke at age 37 and PE which followed a couple months after the stroke (and led to ongoing coumadin treatment).  Would it be possible for you to provide a point of contact to me? Do you know when the trial is expected to begin and how candidates can apply?

Thank you for any information you can provide. 


Posted by Yvonne, Feb 13, 2012 at 07:24 PM, EDT
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This comment is a reply to Yvonne (Feb 16, 2012 at 07:21 PM, EDT)

Thank you for your comments.  And I hope your brother recuperates quickly.  ATTRACT is a randomized trial, so half the participants receive standard care like your brother.  The others receive more aggressive "pharmacomechanical" intervention.  This randomization occurs at the time of initial hospitalization, so your brother does not qualify for enrollment now.

 You can find more details about ATTRACt simply by logging onto the U.S. governments excellent website:  www.clinicaltrials.gov

 

 


Posted by Dr. Sam Goldhaber, Feb 16, 2012 at 07:21 PM, EDT
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Dear Dr. Goldhaber,

I am Dr.Jianing Yue, vascular clinical fellow working in Zhongshan Hospital Shanghai China. I appreciate you provide the video Blog about CaVenT. This is a great study answering a daily clinical question. I have a question about its statistic method. They metioned that one pt had distal femoral DVT at start of the CDT procedure and did not receive alteplase.  Why the study include this pt in the ITT (intention-to-treat) analysis? My idea is this pt should be withdrew and not be calculated into ITT analysis. I will apreciate if you can clarify this confuse. Thanks a lot.


Posted by Jianing Yue, Feb 20, 2012 at 07:09 AM, EDT
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