Basic data related to thrombolytic therapy for acute venous thrombosis.

Area of Science:

• Vascular Medicine
• Interventional Cardiology
• Thrombosis Research

Background:

• Treatment guidelines for iliofemoral deep venous thrombosis (DVT) are based on limited observational and prospective studies.
• The ATTRACT trial is the first large, multicenter randomized control trial for iliofemoral DVT treatment strategies.
• Existing data on catheter-directed thrombolysis (CDT) and pharmacomechanical thrombectomy for acute iliofemoral DVT are limited.

Purpose of the Study:

• To summarize existing data informing the use of catheter-directed thrombolysis (CDT) or pharmacomechanical thrombectomy.
• To provide a foundation for understanding current treatment strategies in acute iliofemoral DVT.
• To contextualize the upcoming results from the ATTRACT trial.

Main Methods:

• A comprehensive literature search was conducted using PubMed, Ovid, and Cochrane databases.
• Searched for articles published up to December 2013.
• Included studies with at least 25 patients, case series, national registry data, and randomized control trials.

Main Results:

• Nineteen case series (1996-2012) and three national registry studies were identified.
• Treatment modalities included anticoagulation, surgical thrombectomy, pharmacomechanical thrombectomy, and CDT.
• Only two randomized control trials (2002-2012) were found, both supporting CDT over anticoagulation alone for iliofemoral DVT.

Conclusions:

• Current treatment guidelines for acute iliofemoral DVT are based on limited clinical data.
• The evidence base for CDT and pharmacomechanical thrombectomy in iliofemoral DVT requires further robust investigation.
• This summary anticipates the findings of the ongoing ATTRACT trial to refine DVT treatment guidelines.