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- W2183291160 abstract "1report a landmark prospective randomised trial (CaVenT) showing the benefi t of catheter-directed thrombolysis (CDT) to treat acute lower limb deep vein thrombosis (DVT). For the past 20 years, a major impediment to widespread adoption of CDT has been the scarcity of data supporting its benefi t, and safety concerns about a minimally invasive procedure using a thrombolytic drug. Thus many patients with acute DVT have had to receive anticoagulation treatment alone, without the benefi t of added low-dose thrombolytic drug to alleviate their symptoms and to prevent chronic debilitation from inadequately treated DVT. Enden and colleagues should be commended for a successful study that addresses these concerns and shows that CDT is an essential treatment option for patients with symptomatic acute DVT of the lower limbs. Enden and co-workers randomised 209 patients in their multicentre study, and the primary study endpoint was incidence of post-thrombotic syndrome at 24 months. Post-thrombotic syndrome refers to the endstage sequelae of DVT, which result from inadequate treatment of acute DVT. When acute DVT is not resolved, the clot hardens, becomes chronically obstructive, and predisposes to post-thrombotic syndrome. Post-thrombotic syndrome has no cure, and leaves patients with permanently painful and swollen legs that reduce their quality of life. In the accompanying study, the investigators recorded a 14·4% absolute risk reduction (95% CI 0·2–27·9, p=0·047) in development of post-thrombotic syndrome for patients given added CDT plus anticoagulation compared with those given anticoagulation alone (41·1% vs 55·6%). Nevertheless, we believe that the incidence of postthrombotic syndrome in the CDT group was still too high—diff erences in patient selection and procedural technique probably contributed to this fi nding. The investigators acknowledge that patients allocated to the CDT group had more extensive thrombosis with pelvic vein involvement than did those in the control group (46% vs 36%). Indeed, proximal (iliofemoral) DVT is a strong predictor of subsequent post-thrombotic" @default.
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- W2183291160 date "2012-01-01" @default.
- W2183291160 modified "2023-09-27" @default.
- W2183291160 title "Catheter-directed thrombolysis for acute DVT" @default.
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