Association of Successful Ultrasound-Accelerated Catheter-Directed Thrombolysis with Postthrombotic Syndrome: A Post Hoc Analysis of the CAVA Trial
| Autor: | Marlène H. W. van de Poel, Hugo ten Cate, Ad Koster, Otmar R. M. Wikkeling, Harm P. Ebben, Rutger J B Brans, Pascale Notten, Louis-Jean Vleming, André A. E. A. de Smet, Cees H. A. Wittens, Lidwine W. Tick, Carsten W. K. P. Arnoldussen, Nils Planken, Esther M. G. Jacobs, Kon-Siong G. Jie, Arina J. ten Cate-Hoek |
|---|---|
| Přispěvatelé: | Radiology and Nuclear Medicine, ACS - Pulmonary hypertension & thrombosis, ACS - Atherosclerosis & ischemic syndromes, Vascular Surgery, RS: Carim - B04 Clinical thrombosis and Haemostasis, MUMC+: DA BV Medisch Specialisten Radiologie (9), Interne Geneeskunde, MUMC+: HVC Trombosezorg (8), MUMC+: MA Alg Interne Geneeskunde (9), MUMC+: HVC Pieken Trombose (9), Surgery, MUMC+: *HVC European Venous Centre (9), Biochemie |
| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_treatment DETERMINANTS Iliac Vein 030204 cardiovascular system & hematology THERAPY Postthrombotic Syndrome 030218 nuclear medicine & medical imaging 0302 clinical medicine Quality of life Single-Blind Method Thrombolytic Therapy DEEP-VEIN THROMBOSIS Aged 80 and over Venous Thrombosis Standard treatment Hematology Thrombolysis Middle Aged Venous thrombosis Female Stents Adult thrombolysis medicine.medical_specialty Adolescent 1ST EPISODE deep vein thrombosis VALIDATION Catheterization Young Adult 03 medical and health sciences thrombolytic agents Fibrinolytic Agents Post-hoc analysis medicine Humans Vascular Patency Thrombus RECURRENCE Ultrasonography Interventional Aged business.industry Femoral Vein medicine.disease Confidence interval Surgery SEVERITY quality of life RISK-FACTORS TRANSLATION business Follow-Up Studies |
| Zdroj: | Thrombosis and haemostasis, 120(8), 1188-1199. Schattauer GmbH Thrombosis and Haemostasis, 120(08), 1188-1199. Georg Thieme Verlag |
| ISSN: | 2567-689X 0340-6245 |
| Popis: | 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 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|