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The Impact of Successful Ultrasound-Accelerated Catheter-Directed Thrombolysis on the Prevention of Post-Thrombotic Syndrome: A Post-Hoc Analysis of the CAVA-Trial

1Maastricht University Medical Center (MUMC+), Heart+Vascular Center, Vascular Surgery, Maastricht, the Netherlands, 2Maastricht University, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands, 3Maastricht University Medical Center (MUMC+), Radiology, Maastricht, the Netherlands, 4Viecuri Medical Center, Radiology and Nuclear Medicine, Venlo, the Netherlands, 5Maasstad Hospital, Vascular Surgery, Rotterdam, the Netherlands, 6Maxima Medical Center, Internal Medicine, Eindhoven, the Netherlands, 7Laurentius Hospital, Internal Medicine, Roermond, the Netherlands, 8Nij Smellinghe Hospital, Vascular Surgery, Drachten, the Netherlands, 9Haga Hospital, Internal Medicine, The Hague, the Netherlands, 10Viecuri Medical Center, Internal Medicine, Venlo, the Netherlands, 11Zuyderland Medical Centre, Internal Medicine, Sittard, the Netherlands, 12Elkerliek Hospital, Internal Medicine, Helmond, the Netherlands, 13Amsterdam University Medical Centers, Vascular Surgery, Amsterdam, the Netherlands, 14Amsterdam University Medical Centers, Radiology and Nuclear Medicine, Amsterdam, the Netherlands, 15Maastricht University, Emeritus Professor of Venous Surgery, Maastricht, the Netherlands, 16Maastricht University Medical Center (MUMC+), Laboratory for Clinical Thrombosis and Haemostasis, Maastricht, the Netherlands, 17Maastricht University Medical Center (MUMC+), Heart+Vascular Center, Thrombosis Expertise Centre, Maastricht, the Netherlands

Abstract Number: PB2206

Meeting: ISTH 2020 Congress

Theme: Venous Thromboembolism and Cardioembolism » Post-thrombotic Syndrome

Background: The CAVA-trial did not show the anticipated risk reduction for post-thrombotic syndrome (PTS) after early thrombus removal via additional ultrasound-accelerated catheter-directed thrombolysis (UACDT) in patients with acute iliofemoral deep-vein thrombosis (IFDVT). Difficulties in achieving an effective degree of recanalization trough thrombolysis may have influenced these outcomes.

Aims: We aimed to assess whether successful thrombolysis with restored patency did reduce the risk of PTS. In addition, we explored determinants of successful thrombolysis and the impact on health related quality of life (QoL).

Methods: A post-hoc analysis of the CAVA-trial was performed to assess the impact of successful UACDT on the development of PTS. The proportion of PTS at 1 year follow-up was compared between patients with successful thrombolysis and patients that received standard treatment only. In addition, clinical success was determined using the Venous Clinical Severity Score (VCSS) and QoL-measures.

Results: UACDT was initiated in 77 (50.7%) patients, of which 41 (53.2%) procedures were considered successful (inter-rater agreement κ=0.69, 95%CI 0.47-0.83). A total of 75 patients received standard treatment only (49.3%). PTS developed in 48 (41.4%) patients: 15 (36.6%) in the successful thrombolysis group versus 33 (44.0%) in the standard treatment group (p=0.44). Successful thrombolysis was associated with lower VCSS (3.50±2.57 versus 4.82±2.74, p=0.02) and higher EQ5D-scores (40.2±36.4 versus 23.4±34.4, p=0.01). Compared to unsuccessful thrombolysis, successful thrombolysis was associated with a shorter symptom duration at inclusion (p=0.05), and higher rates of performed adjunctive procedures (p< 0.001), and stent placement
(p< 0.001).

Conclusions: Successful thrombolysis was not associated with a reduced proportion of PTS 1 year after acute IFDVT compared to patients receiving standard treatment alone. There was however a significant reduction in symptom severity and improvement of generic QoL. Better patient selection and optimization of treatment protocols is needed to achieve the full potential of UACDT for the prevention of PTS.

To cite this abstract in AMA style:

Notten P, Arnoldussen C, Brans R, de Smet A, Tick L, van de Poel M, Wikkeling O, Vleming L-, Koster A, Jie K-, Jacobs E, Ebben H, Planken N, Wittens C, ten Cate H, ten Cate-Hoek AJ. The Impact of Successful Ultrasound-Accelerated Catheter-Directed Thrombolysis on the Prevention of Post-Thrombotic Syndrome: A Post-Hoc Analysis of the CAVA-Trial [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/the-impact-of-successful-ultrasound-accelerated-catheter-directed-thrombolysis-on-the-prevention-of-post-thrombotic-syndrome-a-post-hoc-analysis-of-the-cava-trial/. Accessed September 29, 2023.

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