Deep vein thrombosis (DVT) or ‘blood clot’ commonly affects the leg veins (including the femoral and popliteal veins) or pelvic veins (iliac vein). Complications associated with DVT include pulmonary embolism (PE), which is when a portion, or the entire clot, migrates from its primary location into the lungs. Each year, 600,000 people develop DVT.
Signs and symptoms of DVT are leg pain, swelling, warmth or red discoloration as well as dilation of the superficial veins in the affected limb. A late complication which occurs in 25–33% of patients with DVT is called post thrombotic syndrome (PTS), and typically occurs within 2 years of diagnosis despite appropriate treatment with blood thinners. PTS consists of chronic leg pain (aching or cramping), leg heaviness, itching or tingling, swelling, redness, varicose veins, leg discoloration. These symptoms are typically more pronounced upon standing or walking for long periods and relieved upon rest. PTS can even lead to venous stasis ulcers in some patients.
Treatment options for acute DVT include anticoagulation with blood thinners like heparin or warfarin and pharmacomechanical thrombolysis (PCDT) in which clot busting drugs are delivered into the clot through a small catheter placed inside the blocked vein, followed by mechanical removal of the clot itself. All patients with DVT should be treated with 3–6 months (or longer) of anticoagulation and wear elastic compression stockings which have been shown to reduce the incidence of PTS.
At this point, it is unknown which of the two treatment options is best for reducing the incidence of PTS. A comparative effectiveness trial known as the ATTRACT trial hopes to help answer this question and is currently enrolling patients at MedStar Georgetown University Hospital. The ATTRACT trial is a prospective, NIH-funded, phase III, randomized clinical trial. All patients are treated with anticoagulation, while half are randomized to PCDT treatment prior to anticoagulation. MedStar Georgetown University hospital is a proud member of the ATTRACT study.