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Chapter Nine Venous Disease Coalition

Chapter Nine Venous Disease Coalition. New Therapies for VTE. VTE T oolkit. Iliofemoral DVT has more serious long-term consequences than infra-inguinal DVT After 5 years: - 95% develop chronic venous insufficiency - nearly ½ have venous claudication - 15% develop venous ulcers

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Chapter Nine Venous Disease Coalition

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  1. Chapter Nine Venous Disease Coalition New Therapies for VTE VTE Toolkit

  2. Iliofemoral DVT has more serious long-term consequences than infra-inguinal DVT • After 5 years: • - 95% develop chronic venous insufficiency • - nearly ½ have venous claudication • - 15% develop venous ulcers • - substantially reduced Quality of Life Iliofemoral DVT VTE Toolkit

  3. Potential Benefits of Clot Removal: • More rapid relief of obstruction • Preservation of valve function • Reduction in clot recurrence • Reduction in post-thrombotic morbidity Iliofemoral DVT VTE Toolkit

  4. Catheter-Directed Thrombus Reduction: • Successful thrombolysis • - more rapid return to function • - reduced chronic post-thrombotic symptoms • - improved quality of life • Bleeding  • - Major bleeding <5% • - Intracranial bleeding <1% • Clinical pulmonary embolism <1% Iliofemoral DVT VTE Toolkit

  5. Standard therapy: LMWH or IV heparin overlapping with warfarin Follow-up x 24 mos. Symptomatic iliofemoral DVT Catheter-DirectedThrombolysis in Acute DVT (ATTRACT) R • Standard therapy + pharmaco-mechanical CDT: • Trellis-8 • AngioJetRheolytic system • Intra-thrombus rt-PA infusion N=700 30-50 centers NIH-funded S. Vedantham • Primary efficacy outcome: incidence of PTS at 24 mos (Villalta scale) • Secondary efficacy outcomes: severity of PTS; QOL (disease-specific and general); symptoms; valvular reflux & residual thrombus (at 1 year); cost-effectiveness; predictors of response • Safety outcomes: major bleeding, symptomatic PE, rec VTE, death VTE Toolkit

  6. Standard therapy: IV heparin > 48 h  LMWH overlapping with warfarin Follow-up x 1 mo. Thrombolysis in Acute PE (PEITHO) Submassive PE* N~1,000 2007-2010 G. Meyer R Standard therapy + IV bolus tenecteplase *RV dysfunction on echo or CTPA + elevtroponin but normal BP • Primary outcome:composite of all-cause mortality + hemodynamic collapse (CPR, sBP <90 >15 min) within 7 days • Secondary outcomes:death, hemodynamic collapse, recurrent symptomatic PE, stroke, major bleeding within 7days; death <30 days • Sponsors: Assistance Publique – Hopitaux de Paris, German Ministry of Education & Research, Boehringer-Ingelheim VTE Toolkit

  7. Venous Disease Coalition www.vasculardisease.org/venousdiseasecoalition/ VTE Toolkit

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