6/28/23, 12:48 AM ATTRACT Pathway Feedback Search Clinical Topics Home Studies ATTRACT ATTRACT Disease Disease Deep vein thrombosis Pulmonary embolism Trial question What is the role of pharmacomechanical catheter-directed thrombolysis in reducing the risk of post- thrombotic syndrome in patients with proximal deep vein thrombosis despite treatment with anticoagulant therapy? Study design Multi-center Open label RCT Population Characteristics of study participants 38.0% female N = 692 62.0% male 692 patients (265 female, 426 male) Inclusion criteria: patients with proximal deep vein thrombosis despite treatment with anticoagulant therapy Key exclusion criteria: < 16 or > 75 years of age, pregnant, symptoms for > 14 days, high risk bleeding, active cancer, established post-thrombotic syndrome, or ipsilateral deep vein thrombosis in the previous 2 years Interventions N=337 pharmacomechanical-thrombolysis (catheter-mediated or device-mediated intrathrombus delivery of recombinant tPA and thrombus aspiration or maceration, with or without stenting plus https://web.pathway.md/studies/recShUKhWY9BChDqS 1/2 6/28/23, 12:48 AM ATTRACT Pathway anticoagulation) N=355 medical therapy (anticoagulation alone) Primary outcome Rate of post-thrombotic syndrome between 6 and 24 months 48.0 % 48 47 36.0 % 24.0 % 12.0 % No significant difference 0.0 % Pharmacomechanical-thrombolysis Medical therapy No significant difference in the rate of post-thrombotic syndrome between 6 and 24 months (47% vs. 48%; RR 0.96, 96% CI 0.82 to 1.11) Secondary outcomes Significant decrease in moderate-to-severe post-thrombotic syndrome (18% vs. 24%; RR 0.73, 95% CI 0.54 to 0.98) Safety outcomes No significant difference in death and major bleeding over 24 months. Significant differences in major bleeding during the first 10 days (1.7% vs. 0.3%; p = 0.049; RR 6.18, 95% CI 0.78-49.2) and recurrent VTE within 24 months (12% vs. 8%, p = 0.09). Conclusion In patients with proximal deep vein thrombosis despite treatment with anticoagulant therapy, pharmacomechanical-thrombolysis were not superior to medical therapy with respect to the rate of post-thrombotic syndrome between 6 and 24 months. Reference Vedantham S, Goldhaber SZ, Julian JA et al. Pharmacomechanical Catheter-Directed Thrombolysis for Deep-Vein Thrombosis. N Engl J Med. 2017 Dec 7;377(23):2240-2252. Open reference URL https://web.pathway.md/studies/recShUKhWY9BChDqS 2/2