Relationships between the use of pharmacomechanical catheter-directed thrombolysis, sonographic findings, and clinical outcomes in patients with acute proximal DVT: Results from the ATTRACT Multicenter Randomized Trial
Relationships between the use of pharmacomechanical catheter-directed thrombolysis, sonographic findings, and clinical outcomes in patients with acute proximal DVT: Results from the ATTRACT Multicenter Randomized Trial
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DOI：
10.1177/1358863x19862043
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发表时间：
2019-07-27
影响因子：
3.5
通讯作者：
Jaff, Michael R.
中科院分区：
文献类型：
--
作者：
Weinberg, Ido;Vedantham, Suresh;Jaff, Michael R.
很少有研究证明血管内治疗、双超声检查（DUS）、血栓形成后综合征（PTS）和生活质量（QOL）之间的关系。急性静脉血栓形成：血栓清除与辅助导管定向溶栓（attraction）试验随机分配692例急性近端深静脉血栓形成（DVT）患者接受抗凝或抗凝+药物机械导管定向溶栓（PCDT）治疗。在基线、1个月和12个月分别获得压缩DUS。126例患者在12个月时获得反流DUS。收集超过24个月的临床结果。1个月时，与对照组相比，接受PCDT治疗的患者残留血栓较少，其证据包括不可压缩性股总静脉（CFV）（21%对35%，p < 0.0001）、股静脉（51%对70%，p < 0.0001）和腘静脉（61%对74%，p < 0.0001）。12个月时，在超声亚研究中，两组间瓣膜反流发生率相似（85% vs 91%, p = 0.35）。1个月时CFV不可压缩性与较高的任何PTS发生率（61%对46%，p < 0.001）、较高的中重度PTS发生率（30%对19%，p = 0.003）和较差的生活质量（差8.2静脉功能不全，生活质量的流行病学和经济学研究）相关；P = 0.004)。12个月时瓣膜反流与24个月时中度或重度PTS相关（30% vs 0%, p = 0.01）。总之，PCDT可减少残余血栓，但不能减少静脉瓣膜反流。1个月时CFV不可压缩性与24个月时更多的PTS、更严重的PTS和更差的生活质量相关。瓣膜反流可诱发中度或重度PTS。ClinicalTrials.gov标识符NCT00790335。
Few studies have documented relationships between endovascular therapy, duplex ultrasonography (DUS), post-thrombotic syndrome (PTS), and quality of life (QOL). The Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT) trial randomized 692 patients with acute proximal deep vein thrombosis (DVT) to receive anticoagulation or anticoagulation plus pharmacomechanical catheter-directed thrombolysis (PCDT). Compression DUS was obtained at baseline, 1 month and 12 months. Reflux DUS was obtained at 12 months in a subset of 126 patients. Clinical outcomes were collected over 24 months. At 1 month, patients who received PCDT had less residual thrombus compared to Control patients, evidenced by non-compressible common femoral vein (CFV) (21% vs 35%, p < 0.0001), femoral vein (51% vs 70%, p < 0.0001), and popliteal vein (61% vs 74%, p < 0.0001). At 12 months, in the ultrasound substudy, valvular reflux prevalence was similar between groups (85% vs 91%, p = 0.35). CFV non-compressibility at 1 month was associated with higher rates of any PTS (61% vs 46%, p < 0.001), a higher incidence of moderate-or-severe PTS (30% vs 19%, p = 0.003), and worse QOL (difference 8.2 VEINES-QOL (VEnous INsufficiency Epidemiological and Economic Study on Quality of Life) points; p = 0.004) at 24 months. Valvular reflux at 12 months was associated with moderate-or-severe PTS at 24 months (30% vs 0%, p = 0.01). In summary, PCDT results in less residual thrombus but does not reduce venous valvular reflux. CFV non-compressibility at 1 month is associated with more PTS, more severe PTS, and worse QOL at 24 months. Valvular reflux may predispose to moderate-or-severe PTS. ClinicalTrials.gov Identifier NCT00790335.