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Post-thrombotic syndrome (PTS) is an issue that many patients grapple with after experiencing deep vein thrombosis (DVT). PTS can cause a range of issues in patients, including chronic swelling of the leg, discomfort, varicose veins, and skin ulcers. Traditionally, patients rely on compression therapy and medications to treat PTS.

One of the ways patients can prevent PTS is by wearing compression stockings, prescribed to them by their physician. Systematic thrombolytic therapy and catheter-directed thrombolysis techniques are also an option. These techniques are used less frequently than compression stockings. However, a new trial is looking to change that.

The Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT) trial is designed to test how effective pharmacomechanical catheter-directed thrombolysis (PCDT) is at preventing PTS. Researchers hope that PCDT can become a primary treatment in the prevention of PTS in DVT patients. PCDT involves a physician injecting a fibrinolytic drug directly into the center of a venous thrombus using a catheter.

“This study is wrapping up, and the results will be soon,” explained Dr. Samuel Goldhaber, president of NATF and a researcher involved with the trial, in his February President’s Letter. “The premise of the trial is to test the 'open vein hypothesis' in patients suffering an acute DVT. Patients with large leg DVT are randomized either to standard anticoagulation versus catheter-directed therapy with the clot-busting drug, TPA. The theory is that if the vein can be completely 'cleaned out' with TPA, delivered through a catheter, that the likelihood of long-term adverse effects from the DVT will decrease.”

Trial Design

The ATTRACT trial is a phase III, multicenter, randomized, open-label, assessor-blinded, parallel two-arm, controlled clinical trial. It is sponsored by the National Institutes of Health. 

692 patients with acute proximal DVT are participating in the study. Each of these patients’ DVT involves the femoral, common femoral, or iliac vein. Through randomization, certain patients receive PCDT and anticoagulation drug therapy, while others receive only the anticoagulation drug therapy.

According to the study’s abstract, researchers hypothesize that, “ATTRACT will determine if PCDT should be routinely used to prevent PTS in patients with symptomatic proximal DVT above the popliteal vein.”

The results of this trial are expected to be presented in early March.

For a closer look at the ATTRACT trial, the full abstract can be found here.

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