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Friday, December 4, 2020

Post-Procedure Residual Thrombus and Clinical Outcome in DVT Receiving Pharmacomechanical Thrombolysis

Correlation Between Post-Procedure Residual Thrombus and Clinical Outcome in Deep Vein Thrombosis Patients Receiving Pharmacomechanical Thrombolysis in a Multicenter Randomized Trial


Clinical question

Does residual thrombus on post-procedure venogram correlate with clinical outcomes following phamracomechanical thrombolysis for DVT?

Take-away point
No correlation is noted between volume of residual thrombus and severity of post-thrombotic syndrome.

Reference
Mahmood K Razavi et al. Correlation between Post-Procedure Residual Thrombus and Clinical Outcome in Deep Vein Thrombosis Patients Receiving Pharmacomechanical Thrombolysis in a Multicenter Randomized Trial. Journal of Vascular and Interventional Radiology. 2020: 31; 1517-1528.

Click here for abstract

Study design
Randomized Trial

Funding source
Self-funded or unfunded

Setting
Multi-Center










Summary


This study utilized the ATTRACT trial database to assess the relationship between post-procedure venograms following pharmacomechanical catheter-directed thrombolysis (PCDT) for proximal DVT and outcomes, specifically post thrombotic syndrome. Briefly, 317 patients with ioliofemoral or femoral-popliteal DVT were included. Venograms were assessed for post-procedure thrombus burden and post-thrombotic syndrome and quality of life was measured at 1, 12, and 24 months.

PCDT was noted to significantly reduce thrombus volume in all vein segments. Complete thrombolysis was documented in 30% of the patients. Post-PCDT thrombus burden (as measured by Marder score) did not correlate with 24-month Villalta score, Venous Clinical Severeity Scale, nor venous disease-specific qualtiy of life survey. Within the PCDT arm of the ATTRACT trial, "patients who developed PTS did not have more end-of-procedure residual thrombus than those who did not develop PTS", with PTS seen in 46% of patients with complete thrombolysis and 47% and 53% of patients with minor residual and substantial residual thrombus respectively. Notably, complete thrombolysis was correlated with reduced PTS severity within the iolofemoral DVT cohort.

Commentary


Traditionally, the goal of catheter directed thrombolysis revolved around leaving an open vein-with prompt removal of thrombus burden leading to preserved valvular function and reduced PTS symptoms. Within the ATTRACT trial, PCDT successfully removed thrombus volume and while it had no significant impact on PTS occurence, it was correlated with reduced sypmtoms and better quality of life. This current study further clarifies this study, examining the PCDT outcomes based on venographic results. This data further illuminates our lack of understanding of the pathophysiology behind PTS.

Post Author:

David M Mauro, MD
Assistant Professor
Department of Radiology, Vascular and Interventional Radiology
University of North Carolina

@DavidMauroMD

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