In the Journals

ATTRACT: Catheter-directed thrombolysis may improve quality of life in DVT

Pharmacomechanical catheter-directed thrombolysis improved short-term disease-specific quality of life in patients with proximal deep vein thrombosis, according to new data from the ATTRACT trial.

In addition, pharmacomechanical catheter-directed thrombolysis (PCDT) improved longer-term QOL in the subset of patients with iliofemoral DVT.

The improvement occurred despite PCDT failing to improve postthrombotic syndrome, which often leads to reduced QOL, in the main results of the trial, as Healio previously reported.

“Most of the improvement in QOL was in the first 6 months, and the trial did find that PCDT reduced clot burden and early leg pain and swelling over no PCDT, and was associated with a reduced point prevalence of PTS at 6 months, but not thereafter,” Susan R. Kahn, MD, MSc, from the Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, said in a press release. “Though PCDT did not prevent postthrombotic syndrome, it did reduce its severity.”

For the present analysis, the outcome of interest was change in VEINES-QOL score in 691 patients from ATTRACT (mean age, 53 years; 62% men; 57% with iliofemoral DVT).

In the overall cohort, change in VEINES-QOL score was greater in those assigned PCDT vs. those assigned no PCDT between baseline and 1 month (difference, 5.7; P = .0006) and between baseline and 6 months (difference, 5.1; P = .0029), but not at time points longer than 6 months, Kahn and colleagues wrote.

In patients with iliofemoral DVT, change in VEINES-QOL score was greater in the PCDT group at all time points (1-month difference, 10; P < .0001; 6-month difference, 8.8; P < .0001; 18-month per-protocol difference, 5.8; P = .0086; 24-month per-protocol difference, 6.6; P = .0067), according to the researchers. In addition, in this cohort, SF-36 score change was greater in the PCDT group at 1 month (difference, 3.2; P = .001), but not thereafter.

Among patients with femoral popliteal DVT, there was no difference between the groups in VEINES-QOL score or other QOL measures at any time point.

“Although both measures ask about leg pain, heaviness, cramping, itching and pins and needles sensation, the VEINES-QOL instrument used to measure venous QOL may have captured different clinical characteristics than the Villalta scale used to measure postthrombotic syndrome,” the researchers wrote. – by Erik Swain

Disclosures: The trial was funded in part by Boston Scientific, Covidien/Medtronic and Genentech. Compression stockings were donated by BSN Medical. Kahn reports she received advisory board fees from Aspen, Bristol-Myers Squibb/Pfizer and Sanofi. Please see the study for all other authors’ relevant financial disclosures.

Pharmacomechanical catheter-directed thrombolysis improved short-term disease-specific quality of life in patients with proximal deep vein thrombosis, according to new data from the ATTRACT trial.

In addition, pharmacomechanical catheter-directed thrombolysis (PCDT) improved longer-term QOL in the subset of patients with iliofemoral DVT.

The improvement occurred despite PCDT failing to improve postthrombotic syndrome, which often leads to reduced QOL, in the main results of the trial, as Healio previously reported.

“Most of the improvement in QOL was in the first 6 months, and the trial did find that PCDT reduced clot burden and early leg pain and swelling over no PCDT, and was associated with a reduced point prevalence of PTS at 6 months, but not thereafter,” Susan R. Kahn, MD, MSc, from the Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, said in a press release. “Though PCDT did not prevent postthrombotic syndrome, it did reduce its severity.”

For the present analysis, the outcome of interest was change in VEINES-QOL score in 691 patients from ATTRACT (mean age, 53 years; 62% men; 57% with iliofemoral DVT).

In the overall cohort, change in VEINES-QOL score was greater in those assigned PCDT vs. those assigned no PCDT between baseline and 1 month (difference, 5.7; P = .0006) and between baseline and 6 months (difference, 5.1; P = .0029), but not at time points longer than 6 months, Kahn and colleagues wrote.

In patients with iliofemoral DVT, change in VEINES-QOL score was greater in the PCDT group at all time points (1-month difference, 10; P < .0001; 6-month difference, 8.8; P < .0001; 18-month per-protocol difference, 5.8; P = .0086; 24-month per-protocol difference, 6.6; P = .0067), according to the researchers. In addition, in this cohort, SF-36 score change was greater in the PCDT group at 1 month (difference, 3.2; P = .001), but not thereafter.

Among patients with femoral popliteal DVT, there was no difference between the groups in VEINES-QOL score or other QOL measures at any time point.

“Although both measures ask about leg pain, heaviness, cramping, itching and pins and needles sensation, the VEINES-QOL instrument used to measure venous QOL may have captured different clinical characteristics than the Villalta scale used to measure postthrombotic syndrome,” the researchers wrote. – by Erik Swain

Disclosures: The trial was funded in part by Boston Scientific, Covidien/Medtronic and Genentech. Compression stockings were donated by BSN Medical. Kahn reports she received advisory board fees from Aspen, Bristol-Myers Squibb/Pfizer and Sanofi. Please see the study for all other authors’ relevant financial disclosures.