Key result
Successful ultrasound-accelerated CDT fails to reduce 1-year postthrombotic syndrome versus standard care.
Why the study?
The CAVA trial did not show the anticipated risk reduction for postthrombotic syndrome after thrombus removal via ultrasound-accelerated catheter-directed thrombolysis in acute iliofemoral deep vein thrombosis, and the impact of successful thrombolysis on PTS development was unclear.
Does successful ultrasound-accelerated catheter-directed thrombolysis reduce the development of postthrombotic syndrome in patients with acute iliofemoral deep vein thrombosis compared to standard treatment?
Does successful ultrasound-accelerated catheter-directed thrombolysis reduce the development of postthrombotic syndrome in patients with acute iliofemoral deep vein thrombosis compared to standard treatment?
Successful ultrasound-accelerated catheter-directed thrombolysis did not significantly reduce postthrombotic syndrome at 1 year compared to standard treatment, though it improved symptom severity and quality of life.
Ultrasound-accelerated thrombolysis was not associated with reduced postthrombotic syndrome; leaves open randomized evaluation in iliofemoral DVT.
Background The CAVA trial did not show the anticipated risk reduction for postthrombotic syndrome (PTS) after thrombus removal via additional ultrasound-accelerated catheter-directed thrombolysis (UACDT) in patients with acute iliofemoral deep vein thrombosis (IFDVT). Difficulties in achieving an effective degree of recanalization through thrombolysis may have influenced outcomes. We therefore assessed whether successful UACDT (restored patency ≥ 90%) did reduce the development of PTS. Methods This CAVA trial post hoc analysis compared the proportion of PTS at 1-year follow-up between patients with successful UACDT and patients that received standard treatment only. In addition, clinical impact as well as determinants of successful thrombolysis were explored. Results UACDT was initiated in 77 (50.7%) patients and considered successful in 41 (53.2%, interrater agreement κ = 0.7, 95% confidence interval 0.47–0.83). PTS developed in 15/41 (36.6%) patients in the successful UACDT group versus 33/75 (44.0%) controls (p = 0.44). In this comparison, successful UACDT was associated with lower Venous Clinical Severity Score (3.50 ± 2.57 vs. 4.82 ± 2.74, p = 0.02) and higher EuroQOL-5D (EQ-5D) scores (40.2 ± 36.4 vs. 23.4 ± 34.4, p = 0.01). Compared with unsuccessful UACDT, successful UACDT was associated with a shorter symptom duration at inclusion (p = 0.05), and higher rates of performed adjunctive procedures (p < 0.001) and stent placement (p < 0.001). Conclusion Successful UACDT was not associated with a reduced proportion of PTS 1 year after acute IFDVT compared with patients receiving standard treatment alone. There was, however, a significant reduction in symptom severity and improvement of generic quality of life according to the EQ-5D. Better patient selection and optimization of treatment protocols are needed to assess the full potential of UACDT for the prevention of PTS. Trial Registration Number ClinicalTrials.gov number, NCT00970619.
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Notten et al. (2020) studied Acute iliofemoral deep vein thrombosis (IFDVT) (n=152). Successful ultrasound-accelerated catheter-directed thrombolysis (UACDT) vs. Standard treatment alone was evaluated on Proportion of postthrombotic syndrome (PTS) at 12 months (OR 0.73, 95% CI 0.34-1.61, p=0.44). Successful ultrasound-accelerated catheter-directed thrombolysis did not significantly reduce the proportion of postthrombotic syndrome at 1 year compared with standard treatment alone (OR 0.73, p=0.44).
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