DVT Prophylaxis: First Comparison of Catheter- Directed Thrombolysis versus Standard Care

February 2012 Vol 5, No 1, Special Issue - Conference Highlights ASH

In the first comparative trial of its kind, the Catheter-Directed Venous Thrombolysis (CaVenT) study determined that treating a clot directly with the recombinant, antithrombotic agent alteplase reduced the frequency of postthrombotic syndrome (PTS) and improved long-term outcome in patients with proximal deep-vein thrombosis (DVT) compared with standard anticoagulation methods.

PTS can greatly affect a patient’s quality of life: 1 in 4 patients with DVT will experience PTS, despite having been treated according to current clinical guidelines.

To offset the risk of PTS, alteplase has been used in this setting. “This interventional therapy is expensive,” said CaVenT lead investigator Tone Rønnaug Enden, MD, PhD, of Oslo University Hospital in Norway. “It is also associated with life-threatening bleeding. However, it has become standard care in some centers, despite a complete lack of evidence from randomized, controlled trials.”

This multicenter investigation enrolled 209 adults who had experienced an objectively verified DVT within 21 days of study entry and who met other entry criteria. Patients were randomized to standard treatment (ie, control group) with heparin/warfarin anticoagulation for 6 months, in addition to the use of elastic compression stockings for 24 months, or to standard treatment plus catheter-directed thrombolysis (CDT) with alteplase for up to 96 hours, but not exceeding 20 mg/day.

“This is a minimally invasive percutaneous technique performed with local anesthesia,” said Dr Enden.

End points included measures of outcome for patient-rated criteria of pain, cramps, heaviness, pruritus, and clinician-rated criteria of edema, skin induration, hyperpigmentation, venous ectasia, and ultrasound examination.

At 24-month follow-up, 37 (41.1%) patients in the CDT group had PTS compared with 55 (55.6%) patients in the control group, an absolute risk reduction of 14.4%.

Regarding adverse events, 20 bleeding complications were reported—3 were classified as major and 5 as clinically relevant. The majority of bleeds were related to the puncture site, and no bleeding related to CDT led to a permanently reduced outcome.

Dr Enden concluded that the addition of CDT to standard treatment improved long-term outcomes and should be considered for patients with iliofemoral DVT when there is no contraindicating risk of bleeding. “These results should be taken into account when guidelines are revised.”
 

Related Items
Advances in Cellular Therapies for Hematologic Malignancies Highlighted at ASH 2019
Wayne Kuznar
February 2020 Vol 13, Special Issue: Payers' Perspectives in Oncology published on February 25, 2020 in Conference Highlights ASH
Improving the Standard of Care
R. Donald Harvey, PharmD, FCCP, BCOP
Videos published on January 5, 2016 in Conference Highlights ASH
Real-World Data on Primary Treatment for Mantle-Cell Lymphoma 2000-2011 – A Nordic Lymphoma Group Observational Study
Conference Correspondent published on April 15, 2014 in Conference Highlights ASH
Oral Arsenic Trioxide-Based Regimen as Salvage Treatment for Relapsed or Refractory Mantle-Cell Lymphoma
Conference Correspondent published on April 15, 2014 in Conference Highlights ASH
Vincristine Sulfate Liposome Injection (Marqibo) and Rituximab for Patients with Relapsed and Refractory Diffuse Large B-Cell Lymphoma or Mantle-Cell Lymphoma in Need of Palliative Therapy
Conference Correspondent published on April 15, 2014 in Conference Highlights ASH
Last modified: August 30, 2021
Copyright © The Lynx Group, LLC. All rights reserved.