Ultrasound-accelerated catheter-directed thrombolysis versus anticoagulation for the prevention of post-thrombotic syndrome (CAVA): a single-blind, multicentre, randomised trial

Notten, Pascale; Cate‐Hoek, Arina J. ten; Arnoldussen, Carsten W. K. P.; Strijkers, Rob H. W.; Smet, A.A.E.A. de; Tick, Lidwine W.; Poel, Marlène H. W. van de; Wikkeling, O.R.; Vleming, Louis‐Jean; Koster, Ad; Jie, Kon‐Siong G.; Jacobs, Esther; Ebben, Harm P.; Coppens, Michiel; Toonder, Irwin M.; Cate, Hugo Ten; Wittens, Cees H. A.

doi:10.1016/s2352-3026(19)30209-1

Cited by 147 publications

(164 citation statements)

References 39 publications

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“…40 Similar results were seen in the smaller CAVA (Ultrasound-Accelerated Catheter-Directed Thrombolysis Versus Anticoagulation) trial. 41 The lack of efficacy and, moreover, the increased risk of major bleeding with the addition of catheter -directed thrombolysis to anticoagulation (3.3% vs 0%, 1.7% vs 0.3%, and 5% vs 0% in the CAVENT, ATTRACT, and CAVA trials, respectively), 38,40,41 support current guideline recommendations to consider thrombolysis only if the limb is threatened. 10 Given the increased risk of bleeding in elderly patients, this conservative approach can be likely extrapolated to patients aged over 75 years who were excluded from the CAVENT and ATTRACT trials and underrepresented in the CAVA trial (median [interquartile range] age, 52…”

Section: Definition Of the Elderly And Analyses For This Reviewmentioning

confidence: 90%

“…38,39 These results were not confirmed in 2 recent trials. 40,41 The ATTRACT (Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis) trial, which randomized 692 patients with proximal DVT to receive pharmacomechanical thrombolysis (ie, catheter -directed lysis, mechanical thrombus removal, or both) plus anticoagulation or anticoagulation alone, showed no difference between the treatment arms with regard to occurrence of recurrent VTE, mortality, postthrombotic syndrome, and quality of life between 6 and 24 months after diagnosis. 40 Similar results were seen in the smaller CAVA (Ultrasound-Accelerated Catheter-Directed Thrombolysis Versus Anticoagulation) trial.…”

Section: Definition Of the Elderly And Analyses For This Reviewmentioning

confidence: 99%

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Treatment of venous thromboembolism in elderly patients in the era of direct oral anticoagulants

Tritschler¹,

Castellucci²,

Es³

et al. 2020

Polish Archives of Internal Medicine

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differ between younger and older patients with acute VTE. 7,8 Furthermore, evidence regarding the optimal treatment of VTE in the elderly, including first-choice anticoagulant agents and duration of anticoagulation, is limited, because elderly patients have been underrepresented in clinical trials. 7,9 As a consequence, the 2016 American College of Chest Physicians (ACCP) and the 2019 European Society of Cardiology (ESC) guidelines do not make specific recommendations for elderly patients and only acknowledge the higher risk of bleeding in this population. 10,11 Over the past decade, substantial advances in the treatment of VTE have been made. 12 Most notably, direct oral anticoagulants (DOACs) were introduced, which offer simple treatment regimens across a broad spectrum of patients with VTE. In light of the significant proportion of the elderly among patients with VTE and their distinct risk of VTE-related outcomes, in this review,

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Section: Definition Of the Elderly And Analyses For This Reviewmentioning

confidence: 90%

Section: Definition Of the Elderly And Analyses For This Reviewmentioning

confidence: 99%

Treatment of venous thromboembolism in elderly patients in the era of direct oral anticoagulants

Tritschler¹,

Castellucci²,

Es³

et al. 2020

Polish Archives of Internal Medicine

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“…This can be explained by the fact that venous stenting was and still is a relatively new treatment modality that is not yet performed on a large scale. However, although over time venous stenting is being performed more frequently and experience with these procedures has increased, the risk of developing in‐stent thrombosis following venous stent placement remains high 9 . Another limitation associated with the small sample size is the fact that it is impossible to assess the contribution of specific characteristics of the stents used (eg, type, material, length, diameter), or the interventions performed (eg, stented vein segments, used technique, achieved patency) to the development of in‐stent thrombosis.…”

Section: Discussionmentioning

confidence: 99%

“…Despite adequate conservative treatment involving early anticoagulation, early compression therapy, and early mobilization, PTS will develop in 25%‐50% of patients with an acute iliofemoral DVT 6‐8 . Venous stenting can be performed in the acute phase as an adjunct to catheter‐directed thrombolysis (CDT), when there is underlying venous pathology (ie, iliac vein compression syndromes), or in the chronic phase to alleviate complaints when residual venous obstruction due to postthrombotic changes are present 9‐13 . Venous stenting is most frequently considered for chronic deep venous obstructions, either due to compression syndromes, acquired causes (eg, postthrombotic synechiae), or congenital causes (eg, anatomic anomalies).…”

Section: Introductionmentioning

confidence: 99%

Quality of anticoagulant therapy and the incidence of in‐stent thrombosis after venous stenting

Notten

Laanen

Eijgenraam

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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Background In patients with a venous outflow obstruction following iliofemoral deep vein thrombosis stenting of the venous tract to prevent or alleviate postthrombotic syndrome is applied with increasing frequency. The impact of the quality of anticoagulant therapy with vitamin K antagonists (VKAs) on the development of in‐stent thrombosis is currently unknown. Objectives To determine the association between the quality of postinterventional VKA treatment and the occurrence of in‐stent thrombosis. Methods Seventy‐nine patients with iliofemoral and/or caval venous stent placement for obstruction of the venous outflow were included in this study. All patients received postinterventional VKA. The quality of VKA anticoagulant therapy was expressed as the time within therapeutic range (TTR) calculated using the linear interpolation method and as the proportion of International Normalized Ratio (INR) values < 2.0. In‐stent thrombosis was assessed by the use of duplex ultrasound. Survival analysis (Kaplan‐Meier curves, Cox regression) was used to analyze the data. Results In‐stent thrombosis developed in 16 patients (20.3%). The total population had a mean TTR of 64.0% (±19.0) and a mean proportion of INR values < 2.0 of 11.6% (±12.0). Overall, a TTR < 49.9% was associated with an increased risk of in‐stent thrombosis. The multivariable adjusted analysis showed a hazard ratio (HR) of 0.96 (95% confidence interval [CI], 0.92‐0.99; P = .02) per 1% increase in TTR. The proportion of INR values < 2.0 had no significant association with the occurrence of in‐stent thrombosis: HR 0.98 (95% CI, 0.91‐1.06; P = .66). Conclusions We conclude that the quality of anticoagulant treatment reflected in the TTR following a venous stenting procedure is an important independent determinant for the risk of in‐stent thrombosis. The role of anticoagulant treatment for the prevention of in‐stent thrombosis following stenting procedures therefore merits further research.

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“…On the other hand, major bleeding occurred in four patients in the ultrasound-assisted CDT group, whereas none occurred in the standard therapy group. 62 Taken together, these studies suggest that CDT and related techniques do not provide a significant clinical benefit that could justify use as the routine, first-line therapy for patients with DVT. However, in symptomatic patients with extensive thrombus (i.e., iliofemoral DVT), these procedures appear to provide better relief of presenting symptoms and may improve long-term QOL.…”

Section: Cather-directed Thrombolysis In Gi Cancer-associated Vtementioning

confidence: 95%

Gastrointestinal Malignancies and Venous Thromboembolic Disease: Clinical Significance and Endovascular Interventions

Partovi

Gadani

et al. 2020

Digestive Disease Interventions

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Gastrointestinal malignancy encompasses a wide range of disease processes. Its incidence and mortality rate rank among the highest of all cancers. Venous thromboembolic disease is a common complication of gastrointestinal malignancy. Anticoagulation remains the first-line therapy. However, for patients who cannot tolerate or have failed anticoagulation, inferior vena cava (IVC) filter placement may be an option. Furthermore, to improve symptom resolution and reduce the severity of postthrombotic syndrome, catheter-directed thrombolysis (CDT) may be an option. Recent randomized trials including the ATTRACT (Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis) trial have shed new light on the efficacy and safety of CDT and related methods. Overall, the decision to proceed with IVC filter placement or CDT must be individualized.

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Ultrasound-accelerated catheter-directed thrombolysis versus anticoagulation for the prevention of post-thrombotic syndrome (CAVA): a single-blind, multicentre, randomised trial

Cited by 147 publications

References 39 publications

Treatment of venous thromboembolism in elderly patients in the era of direct oral anticoagulants

Treatment of venous thromboembolism in elderly patients in the era of direct oral anticoagulants

Quality of anticoagulant therapy and the incidence of in‐stent thrombosis after venous stenting

Gastrointestinal Malignancies and Venous Thromboembolic Disease: Clinical Significance and Endovascular Interventions

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