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Quality of life after pharmacomechanical catheter-directed thrombolysis for proximal deep venous thrombosis. J Vasc Surg Venous Lymphat Disord 2020 01;8(1):8-23.e18

Date

12/18/2019

Pubmed ID

31843251

Pubmed Central ID

PMC7681916

DOI

10.1016/j.jvsv.2019.03.023

Scopus ID

2-s2.0-85076053910   30 Citations

Abstract

BACKGROUND: After deep venous thrombosis (DVT), many patients have impaired quality of life (QOL). We aimed to assess whether pharmacomechanical catheter-directed thrombolysis (PCDT) improves short-term or long-term QOL in patients with proximal DVT and whether QOL is related to extent of DVT.

METHODS: The Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT) trial was an assessor-blinded randomized trial that compared PCDT with no PCDT in patients with DVT of the femoral, common femoral, or iliac veins. QOL was assessed at baseline and 1A month, 6A months, 12A months, 18A months, and 24A months using the Venous Insufficiency Epidemiological and Economic Study on Quality of Life/Symptoms (VEINES-QOL/Sym) disease-specific QOL measure and the 36-Item Short Form Health Survey (SF-36) physical component summary (PCS) and mental component summary general QOL measures. Change in QOL scores from baseline to assessment time were compared in the PCDT and no PCDT treatment groups overall and in the iliofemoral DVT and femoral-popliteal DVT subgroups.

RESULTS: Of 692 ATTRACT patients, 691 were analyzed (mean age, 53A years; 62% male; 57% iliofemoral DVT). VEINES-QOL change scores were greater (ie, better) in PCDT vs no PCDT from baseline to 1A month (difference, 5.7; PA = .0006) and from baseline to 6A months (5.1; PA = .0029) but not for other intervals. SF-36 PCS change scores were greater in PCDT vs no PCDT from baseline to 1A month (difference, 2.4; PA = .01) but not for other intervals. Among iliofemoral DVT patients, VEINES-QOL change scores from baseline to all assessments were greater in the PCDT vs no PCDT group; this was statistically significant in the intention-to-treat analysis at 1A month (difference, 10.0; PA < .0001) and 6A months (8.8; PA < .0001) and in the per-protocol analysis at 18A months (difference, 5.8; PA = .0086) and 24A months (difference, 6.6; PA = .0067). SF-36 PCS change scores were greater in PCDT vs no PCDT from baseline to 1A month (difference, 3.2; PA = .0010) but not for other intervals. In contrast, in femoral-popliteal DVT patients, change scores from baseline to all assessments were similar in the PCDT and no PCDT groups.

CONCLUSIONS: Among patients with proximal DVT, PCDT leads to greater improvement in disease-specific QOL than no PCDT at 1A month and 6A months but not later. In patients with iliofemoral DVT, PCDT led to greater improvement in disease-specific QOL during 24A months.

Author List

Kahn SR, Julian JA, Kearon C, Gu CS, Cohen DJ, Magnuson EA, Comerota AJ, Goldhaber SZ, Jaff MR, Razavi MK, Kindzelski AL, Schneider JR, Kim P, Chaer R, Sista AK, McLafferty RB, Kaufman JA, Wible BC, Blinder M, Vedantham S, ATTRACT Trial Investigators

Author

William S. Rilling MD, FSIR Vice Chair, Professor in the Radiology department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Female
Femoral Vein
Fibrinolytic Agents
Humans
Iliac Vein
Male
Mechanical Thrombolysis
Middle Aged
Quality of Life
Surveys and Questionnaires
Thrombolytic Therapy
Time Factors
Treatment Outcome
United States
Venous Thrombosis