Clinical Outcomes of a Pharmacomechanical Catheter-Directed Venous Thrombolysis Strategy that Included Rheolytic Thrombectomy in a Multicenter Randomized Trial.
Clinical Outcomes of a Pharmacomechanical Catheter-Directed Venous Thrombolysis Strategy that Included Rheolytic Thrombectomy in a Multicenter Randomized Trial.
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一项多中心随机试验中包括流变性血栓切除术的药物机械导管导向静脉溶栓策略的临床结局。
DOI：
10.1016/j.jvir.2021.06.001
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发表时间：
2021-09
期刊：
影响因子：
--
通讯作者：
Kahn SR
中科院分区：
文献类型：
--
作者：
Vedantham S;Salter A;Lancia S;Lewis L;Thukral S;Kahn SR
描述药物力学导管导向静脉溶栓（PCDT）策略的临床结局，包括AngioJet流变血栓切除术。在急性静脉血栓形成：使用辅助导管引导的溶栓进行血栓清除的多中心随机试验中，33家临床试验机构的医生将AngioJet指定为PCDT的首选器械。在这些研究中心，364名患有急性近端下肢深静脉血栓形成（DVT）的患者被随机分配接受PCDT策略，该策略包括AngioJet沿着抗凝治疗或单独抗凝治疗。在30天的随访中评价了DVT症状的缓解情况。随访24个月，评价血栓后综合征（PTS）、生活质量（QOL）、复发性静脉血栓栓塞（VTE）和安全性。在30天内，AngioJet-PCDT导致腿部肿胀的更大改善（小腿围平均差0.55 cm，P = 0.009），静脉QOL（平均差异6.5静脉功能不全流行病学和经济研究[VEINES]-QOL分，P = .0073），静脉症状（平均差异5.6静脉症状分，P = .0134）与对照组相比，其中髂股深静脉血栓形成的差异最为明显。AngioJet-PCDT在6个月时降低了PTS（AngioJet-PCDT组为24%，对照组为40%，P = 0.003），但在12至24个月期间不影响PTS或QOL。AngioJet-PCDT很少发生大出血、肺栓塞、肾衰竭和心动过缓（各<2%），但24个月VTE复发可能更频繁（AngioJet-PCDT组13.9% vs对照组6.8%，P = 0.03）在急性近端DVT患者中，治疗策略包括一线AngioJet-与单独抗凝治疗相比，PCDT相当安全，1个月时改善了症状状态和静脉QOL，6个月时降低了PTS。然而，AngioJet-PCDT在6个月后不影响PTS或QOL，并可能增加复发性VTE。
To describe the clinical outcomes of a pharmacomechanical catheter-directed venous thrombolysis (PCDT) strategy that included AngioJet rheolytic thrombectomy. In the Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis multicenter randomized trial, physicians at 33 sites designated AngioJet as their preferred device for PCDT. In these sites, 364 patients with acute proximal lower-extremity deep vein thrombosis (DVT) were randomized to a strategy of PCDT that incorporated either AngioJet along with anticoagulation or anticoagulation alone. Relief from presenting DVT symptoms was evaluated over 30 days of follow-up. Postthrombotic syndrome (PTS), quality of life (QOL), recurrent venous thromboembolism (VTE), and safety were evaluated over 24 months of follow-up. Within 30 days, AngioJet-PCDT led to a greater improvement in leg swelling (mean difference calf circumference 0.55 cm, P = .009), venous QOL (mean difference 6.5 Venous Insufficiency Epidemiologic and Economic Study [VEINES]-QOL points, P = .0073), and venous symptoms (mean difference 5.6 VEINES-symptoms points, P = .0134) than control, with differences most apparent in iliofemoral DVT. AngioJet-PCDT reduced PTS at 6 months (24% with AngioJet-PCDT vs 40% with control, P = .003) but did not influence PTS or QOL between 12 and 24 months. Major bleeding, pulmonary embolism, renal failure, and bradycardia were infrequent with AngioJet-PCDT (<2% each), but 24-month VTE recurrence may have been more frequent (13.9% with AngioJet-PCDT vs 6.8% with control, P = .03) In patients with acute proximal DVT, a treatment strategy that included first-line AngioJet-PCDT was reasonably safe and led to an improved symptom status and venous QOL at 1 month and reduced PTS at 6 months compared with anticoagulation alone. However, AngioJet-PCDT did not influence PTS or the QOL beyond 6 months and may have increased recurrent VTE.
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DOI：
10.1056/nejmoa1615066
发表时间：
2017-12-07
期刊：
The New England journal of medicine
影响因子：
--
作者：
Vedantham S;Goldhaber SZ;Julian JA;Kahn SR;Jaff MR;Cohen DJ;Magnuson E;Razavi MK;Comerota AJ;Gornik HL;Murphy TP;Lewis L;Duncan JR;Nieters P;Derfler MC;Filion M;Gu CS;Kee S;Schneider J;Saad N;Blinder M;Moll S;Sacks D;Lin J;Rundback J;Garcia M;Razdan R;VanderWoude E;Marques V;Kearon C;ATTRACT Trial Investigators
通讯作者：
ATTRACT Trial Investigators
影响因子：
2.6
作者：
Sharifi, Mohsen;Bay, Curt;Sharifi, Jalaladdin
通讯作者：
Sharifi, Jalaladdin
DOI：
10.1097/01.rvi.0000197359.26571.c2
发表时间：
2006-03-01
影响因子：
2.9
作者：
Vedantham, S;Grassi, CJ;Sacks, D
通讯作者：
Sacks, D
影响因子：
6.7
作者：
Kearon, Clive;Gu, Chu-Shu;Vedantham, Suresh
通讯作者：
Vedantham, Suresh
影响因子：
3.5
作者：
Weinberg, Ido;Vedantham, Suresh;Jaff, Michael R.
通讯作者：
Jaff, Michael R.