  Since the 1960's, patients who develop deep vein thrombosis, or blood clots in the legs, have been treated with blood thinners. Now, 50 years later, newer clot-busting therapies may soon be added to the standard of care.
Deep Vein Thrombosis
Deep vein thrombosis (DVT) is a condition caused by the formation of a blood clot in a deep vein, usually one in the leg. Symptoms can include pain, tenderness, swelling or redness in the affected leg.
The exact incidence of DVT isn’t known because many people don’t have symptoms and the clot dissolves on its own. However, researchers estimate 5 percent of Americans will develop the condition at some point in their lives. Prolonged bed rest, sitting for a long time (like in a plane or car), cigarette smoking, obesity, pregnancy, injury to a deep vein and recent surgery are associated with an increased risk for DVT. Cancer patients and those with certain types of blood disorders are also at higher risk for the condition.
The biggest risk with DVT occurs when the clot breaks free, travels through the bloodstream and become stuck in an artery in the lung (called a pulmonary embolism). This condition interferes with the lung function and can lead to shortness of breath, pain while taking a deep breath, coughing up blood or rapid breathing. In some cases, a pulmonary embolism can be fatal.
Even if a clot remains in place, it can still pose a problem. Veins carry deoxygenated blood back to the heart. A deep vein clot can impede or block the flow of blood and damage the vein. Chronic blockage in a vein, called post-thrombotic syndrome (PTS), can lead to pain, heaviness, swelling and fatigue in the affected leg. In severe cases, PTS can interfere with the ability to walk, work or perform daily activities. Researchers estimate about 20 to 50 percent of patients with deep vein thrombosis develop PTS, usually within one to two years of clot formation.
Treating DVT: The ATTRACT Study
The standard therapy for DVT is use of anticoagulant (blood thinning) medications to reduce the risk of pulmonary embolism and compression stockings to keep venous blood from pooling in the leg. But the treatment doesn’t eliminate the clot and blood flow can still be impeded in the vein, leading to PTS.
Researchers are now trying to determine if use of the clot-busting medication, t-PA, in addition to standard blood thinners, may prevent or reduce the risk for PTS in patients who have been diagnosed with a deep vein clot. The study is called ATTRACT, or Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis.
The ATTRACT study will enroll close to 700 patients with DVT at more than 45 sites across the country. Half the patients will receive the standard care of anticoagulant drugs and compression stockings. The other half will have standard care plus an injection of t-PA directly into the site of the blood clot through a catheter. T-PA will be administered for up to 24 hours.
Although t-PA is approved for treatment of blood clots in the coronary arteries, it is not approved for DVT. Suresh Vedantham, M.D., Interventional Radiologist at Washington University in St. Louis, says researchers are hopeful the trial will show that t-PA is effective for breaking up deep vein clots and can prevent the onset of PTS. For information about the ATTRACT Study, or to locate the nearest study site, go to http://www.clinicaltrials.gov, then type the trial identification number in the search box: Trial ID: NCT00790335. Information about the trial is also available at http://www.attract.wustl.edu.
AUDIENCE INQUIRYFor information about the ATTRACT Study, click here. Information about the trial is also available at http://www.attract.wustl.edu.
For information about deep vein thrombosis:
National Heart, Lung and Blood Institute, http://www.nhlbi.nih.gov
Society for Vascular Surgery, http://www.vascularweb.org
Vascular Disease Foundation, http://www.venousdiseasecoalition.org
Research compiled and edited by Barbara J. Fister
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