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Suresh Vedantham, M.D. Interventional Radiologist Associate Professor of Radiology & Surgery Washington University Schoo PowerPoint Presentation
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Will Clot-Busting Therapies Revolutionize DVT Care?. Suresh Vedantham, M.D. Interventional Radiologist Associate Professor of Radiology & Surgery Washington University School of Medicine Vice-Chair, Venous Disease Coalition. What Most DVT Survivors Don’t Know EARLY Quality of Life.

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Will Clot-Busting Therapies Revolutionize DVT Care?

Suresh Vedantham, M.D.

Interventional Radiologist

Associate Professor of Radiology & Surgery

Washington University School of Medicine

Vice-Chair, Venous Disease Coalition

what most dvt survivors don t know early quality of life
What Most DVT Survivors Don’t Know EARLY Quality of Life
  • DVT patients: severe leg pain & swelling - blood clot blocks vein
  • Improves gradually over weeks to months
  • In 1/3 patients, QOL does not recover (4 mo)
    • Kahn SR et al. J Clin Epidemiol 2006.
what most dvt survivors don t know late quality of life
What Most DVT Survivors Don’t KnowLATE Quality of Life

Post-Thrombotic Syndrome (PTS) causes chronic leg pain, fatigue, swelling, skin changes, and ulcers

PTS is common (25-50% of patients) lifelong, impairs QOL, and has no consistently effective treatments

Venous ulcers often recur and are difficult and expensive to treat

what most dvt survivors don t know late quality of life5
Normal veins have one-way valves

Despite use of blood-thinning drugs, blood clots permanently damage the valves (causing “reflux”) and block venous blood flow (“obstruction”)

Markel A et al. J Vasc Surg 1992.

Meissner MH et al. J Vasc Surg 1998.

What Most DVT Survivors Don’t KnowLATE Quality of Life
the open vein hypothesis it s the clot stupid
THE OPEN VEIN HYPOTHESIS“It’s the Clot, Stupid”

Can immediate clot removal speed relief of DVT symptoms, save venous valves, and prevent PTS?

Elliott 1979 – lysis with SK

Arnesen 1982 – lysis with SK

Plate 1984 & 1990 - surgery

Turpie 1990– lysis with SK

what many doctors don t know
What Many Doctors Don’t Know
  • SIR (2006): Acute iliofemoral DVT patients more likely to be symptom free with better QOL and an open, non-refluxing vein if they also receive CDT
    • Comerota AJ et al. J Vasc Surg 2000; 32:130-137.
    • AbuRahma AF et al. Ann Surg 2001; 233:752-760.
    • Elsharawy M et al. Eur J Vasc Surg 2002; 24:209-214.
  • ACCP (2008): Suggest PCDT for patients with extensive proximal (i.e. acute iliofemoral) DVT
    • Kearon C et al. Chest 2008; 133 Suppl:454S-545S.
the attract trial
The ATTRACT Trial
  • Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis
    • NHLBI-funded ($10 million), Phase III, 28-Center RCT
    • 692 patients with symptomatic, acute proximal DVT
    • 1:1 randomization: PCDT + AC/ECS vs AC/ECS alone
    • Outcomes: PTS, QOL, symptom relief, safety, cost
    • Enrollment to begin 4th quarter 2008
    • Leaders: Vedantham (PI), Goldhaber (Study Chair)
    • Diverse physician network, SIR Foundation, AVF, ACP
clot busting treatment a r evolution yes already
Clot-Busting Treatment: A revolution?YES, Already!
  • DVT research leaders, NIH, many physicians know that PTS prevention is IMPORTANT
  • Fast, safe, convenient PCDT methods AVAILABLE
  • 2008 practice guidelines concordant in favor of early PCDT for patients most likely to benefit: extensive proximal DVT or massive PE
clot busting treatment a r evolution yes if the attract trial is positive
Clot-Busting Treatment: A Revolution?YES, if the ATTRACT Trial is positive
  • Since 1960: DVT treatment aimed at preventing PE and recurrent DVT with blood-thinning drugs
  • New DVT Treatment Paradigm guided by the Open Vein Hypothesis – use blood-thinners but also remove the clot, open the vein, and prevent PTS!
to revolutionize dvt care be active not passive about dvt
To REVOLUTIONIZE DVT CareBe ACTIVE, not Passive, about DVT!
  • 2013 – WHAT PATIENTS & DOCTORS WILL DO
  • When at risk, ask about DVT/PE prevention
  • Receive hospital-mandated DVT/PE prophylaxis
  • Seek immediate care for symptoms of a “leg attack”
  • Routinely use compression therapy to prevent PTS
  • Routinely consider proven clot-busting therapies
  • EDUCATE – Support the Venous Disease Coalition!