CINXE.COM

<!DOCTYPE html> <html dir="ltr" lang="en"> <head> <meta http-equiv="X-UA-Compatible" content="IE=Edge"> <meta charset="utf-8"> <meta name="viewport" content="width=device-width, initial-scale=1"> <link rel="apple-touch-icon" sizes="180x180" href="/assets/images/favicons/apple-touch-icon.png"> <link rel="icon" type="image/png" href="/assets/images/favicons/favicon-32x32.png" sizes="32x32"> <link rel="icon" type="image/png" href="/assets/images/favicons/favicon-16x16.png" sizes="16x16"> <link rel="mask-icon" href="/assets/images/favicons/safari-pinned-tab.svg" color="#5bbad5"> <meta name="description" content="Farouc Jaffer, MD, PhD, and Wenzhu Li, MD, and colleagues have provided experimental and clinical evidence that the benefit of catheter-based intervention for reducing the post-thrombotic syndrome aft" > <title>Reducing Post-Thrombotic Syndrome Through Reperfusion After DVT May Be Time-Sensitive - Mass General Advances in Motion</title> <link rel="canonical" href="https://advances.massgeneral.org/cardiovascular/journal.aspx?id=1899"> <meta name="specialty-detail" content="Cardiovascular|/cardiovascular/specialty.aspx?id=1002"> <meta name="specialty-detail" content="Pulmonary and Critical Care|/pulmonary/specialty.aspx?id=1012"> <meta name="specialty" content="Cardiovascular"> <meta name="specialty" content="Pulmonary and Critical Care"> <meta name="topic-detail" content="Thrombosis|/cardiovascular/topic.aspx?id=1091"> <meta name="topic" content="Thrombosis"> <meta name="pubDate" content="April 8, 2021"> <meta name="hubContentType" content="Journal"> <meta property="og:locale" content="en_US"> <meta property="og:url" content="https://advances.massgeneral.org/cardiovascular/journal.aspx?id=1899"> <meta property="og:site_name" content="Mass General Advances in Motion"> <meta property="og:title" content="Reducing Post-Thrombotic Syndrome Through Reperfusion After DVT May Be Time-Sensitive"> <meta property="og:description" content="Farouc Jaffer, MD, PhD, and Wenzhu Li, MD, and colleagues have provided experimental and clinical evidence that the benefit of catheter-based intervention for reducing the post-thrombotic syndrome aft"> <meta property="og:article" content="Cardiovascular"> <meta property="og:article" content="Pulmonary and Critical Care"> <meta property="og:article" content="Thrombosis"> <meta property="article:publisher" content="http://www.facebook.com/massgeneral"> <meta name="twitter:card" content="summary"> <meta name="twitter:site" content="@MassGeneralNews"> <link href="/assets/styles/index.css" rel="stylesheet"> <link href="/assets/styles/jquery-ui-min.css" rel="stylesheet"> <link href="https://use.typekit.net/sgz4evs.css" rel="stylesheet"> <script> window.dataLayer = window.dataLayer || []; dataLayer = [{ 'postType': 'Journal', 'specialty': 'Cardiovascular,Pulmonary and Critical Care', 'topic': 'Thrombosis' }]; </script> <script src="/assets/scripts/jquery-3.2.1.min.js" ></script> </head> <body>  <a class="a11y-skip-link" href="#main-content">Skip to content</a>   <script type="text/javascript"> (function(window, document, dataLayerName, id) { window[dataLayerName]=window[dataLayerName]||[],window[dataLayerName].push({start:(new Date).getTime(),event:"stg.start"});var scripts=document.getElementsByTagName('script')[0],tags=document.createElement('script'); function stgCreateCookie(a,b,c){var d="";if(c){var e=new Date;e.setTime(e.getTime()+24*c*60*60*1e3),d="; expires="+e.toUTCString()}document.cookie=a+"="+b+d+"; path=/"} var isStgDebug=(window.location.href.match("stg_debug")||document.cookie.match("stg_debug"))&&!window.location.href.match("stg_disable_debug");stgCreateCookie("stg_debug",isStgDebug?1:"",isStgDebug?14:-1); var qP=[];dataLayerName!=="dataLayer"&&qP.push("data_layer_name="+dataLayerName),isStgDebug&&qP.push("stg_debug");var qPString=qP.length>0?("?"+qP.join("&")):""; tags.async=!0,tags.src="https://mgb.containers.piwik.pro/"+id+".js"+qPString,scripts.parentNode.insertBefore(tags,scripts); !function(a,n,i){a[n]=a[n]||{};for(var c=0;c<i.length;c++)!function(i){a[n][i]=a[n][i]||{},a[n][i].api=a[n][i].api||function(){var a=[].slice.call(arguments,0);"string"==typeof a[0]&&window[dataLayerName].push({event:n+"."+i+":"+a[0],parameters:[].slice.call(arguments,1)})}}(i[c])}(window,"ppms",["tm","cm"]); })(window, document, 'dataLayer', '41b8ae76-3079-47d5-aaf8-040ee367d152'); </script>  <header class="site-header" data-header="main"> <div class="site-header__nav-container"> <span class="site-header__logo"> <a href="https://www.massgeneral.org">Massachusetts General Hospital</a> </span> <div class="nav__primary__item -search mobile__search-toggle"> <button id="mobile__search-trigger" data-nav="trigger"> <span class="a11y-sr-only">Search</span> </button> </div> <button class="site-nav__toggle" aria-controls="site-navigation" aria-haspopup="true" aria-expanded="false" data-module="nav-toggle"> <span class="a11y-sr-only">Menu</span> </button> </div> <div class="site-header__sub-block" data-header="sub"> <p class="site-header__tagline"> <a href="/default.aspx">Advances in <i>Motion</i></a> </p> </div> <nav aria-label="Main navigation" class="site-nav" id="site-navigation"> <ul class="nav__utility" role="presentation"> <li><a href="/event-education-listing.aspx">Education & Training</a></li> <li><a href="/clinical-trial-listing.aspx">Clinical Trials</a></li> <li><a href="https://www.massgeneral.org/appointments-and-referrals/referral-request">Refer a Patient</a></li> <li><a href="https://www.massgeneral.org/doctors/">Find a Doctor</a></li> <li><a href="https://www.massgeneral.org/research/">Research Institute</a></li> <li><a class="nav__utility--highlight" href="https://advances.massgeneral.org/subscription.aspx">Subscribe</a></li> </ul> <ul class="nav__primary" data-module="navigation" role="presentation"> <li> <a class="nav__primary__trigger -home-link" href="/default.aspx"> <span class="nav__link-wrapper">Advances in Motion Home</span> </a> </li> <li class="nav__primary__item"> <a class="nav__primary__trigger" data-nav="trigger" data-nav-target="nav-specialties" href="/specialty-listing.aspx"> <span class="nav__link-wrapper">Specialties</span></a> <div class="nav__primary__dropdown" data-nav="target" id="nav-specialties"> <ul class="nav__primary__dropdown__links" role="presentation"> <li><a href="https://advances.massgeneral.org/cardiovascular/specialty.aspx?id=1002">Cardiovascular</a></li> <li><a href="https://advances.massgeneral.org/digestive-health/specialty.aspx?id=1007">Digestive Health</a></li> <li><a href="https://advances.massgeneral.org/endocrinology/specialty.aspx?id=1015">Endocrinology</a></li> <li><a href="https://advances.massgeneral.org/geriatrics/specialty.aspx?id=1009">Geriatrics & Palliative Care</a></li> <li><a href="https://advances.massgeneral.org/neuro/specialty.aspx?id=1004">Neuroscience</a></li> <li><a href="https://advances.massgeneral.org/obgyn/specialty.aspx?id=1006">OB/GYN</a></li> <li><a href="https://advances.massgeneral.org/oncology/specialty.aspx?id=1008">Oncology</a></li> <li><a href="https://advances.massgeneral.org/ophthalmology/specialty.aspx?id=1014">Ophthalmology</a></li> <li><a href="https://advances.massgeneral.org/ortho/specialty.aspx?id=1003">Orthopaedics</a></li> <li><a href="https://advances.massgeneral.org/otolaryngology/specialty.aspx?id=1016">Otolaryngology</a></li> <li><a href="https://advances.massgeneral.org/pulmonary/specialty.aspx?id=1012">Pulmonary & Critical Care</a></li> <li><a href="https://advances.massgeneral.org/radiology/specialty.aspx?id=1013">Radiology</a></li> <li><a href="https://advances.massgeneral.org/rheumatology/specialty.aspx?id=1010">Rheumatology, Allergy & Immunology</a></li> <li><a href="https://advances.massgeneral.org/urology/specialty.aspx?id=1005">Urology</a></li> </ul> <p class="fat-link__wrapper u-text-right"> <a class="fat-link -caret" href="/specialty-listing.aspx">View All Specialties</a> </p> </div> </li> <li class="nav__primary__item"> <a class="nav__primary__trigger" data-nav="trigger" data-nav-target="nav-topics" href="/topic-listing.aspx"> <span class="nav__link-wrapper">Topics</span> </a> <div class="nav__primary__dropdown -topics" data-nav="target" id="nav-topics"> <h4>Recently Updated</h4> <div class="nav__primary__dropdown__flex-container" id="topics-scroll-container"> <section class="flex-container__section"> <ul class="flex-container__links -alt" role="presentation"> <li> <a href="/research-and-innovation/topic.aspx?id=1114" target="_blank">Gene and Cell Therapy</a><p>November 5, 2024</p> </li> <li> <a href="/otolaryngology/topic.aspx?id=1113" target="_blank">Hearing Loss</a><p>November 5, 2024</p> </li> <li> <a href="/research-and-innovation/topic.aspx?id=1107" target="_blank">Women's Health</a><p>November 5, 2024</p> </li> <li> <a href="/neuro/topic.aspx?id=1038" target="_blank">Alzheimer's Disease</a><p>October 1, 2024</p> </li> <li> <a href="/neuro/topic.aspx?id=1018" target="_blank">Neurology</a><p>October 1, 2024</p> </li> <li> <a href="/oncology/topic.aspx?id=1059" target="_blank">Colorectal Cancer</a><p>September 11, 2024</p> </li> <li> <a href="/neuro/topic.aspx?id=1031" target="_blank">Depression</a><p>September 10, 2024</p> </li> <li> <a href="/neuro/topic.aspx?id=1017" target="_blank">Psychiatry</a><p>September 10, 2024</p> </li> <li> <a href="/neuro/topic.aspx?id=1029" target="_blank">Addiction</a><p>September 4, 2024</p> </li> <li> <a href="/neuro/topic.aspx?id=1043" target="_blank">Traumatic Brain Injury</a><p>September 2, 2024</p> </li> </ul> </section> <section class="flex-container__section"> <h5>Featured</h5> <ul class="flex-container__links" role="presentation"> <li> <a href="https://advances.massgeneral.org/ortho/topic.aspx?id=1009">Sports Medicine</a> </li> <li> <a href="https://advances.massgeneral.org/research-and-innovation/topic.aspx?id=1056">COVID-19</a> </li> <li> <a href="https://advances.massgeneral.org/neuro/topic.aspx?id=1024">Neurodegenerative Disease</a> </li> <li> <a href="https://advances.massgeneral.org/pulmonary/topic.aspx?id=1058">ARDS</a> </li> <li> <a href="https://advances.massgeneral.org/research-and-innovation/topic.aspx?id=1068">Telemedicine</a> </li> </ul> </section> </div> <p class="fat-link__wrapper u-text-right"> <a class="fat-link -caret" href="/topic-listing.aspx">View All Topics</a> </p> </div> </li> <li> <a class="nav__primary__trigger" href="/multimedia-listing.aspx"> <span class="nav__link-wrapper">Multimedia</span> </a> </li> <li class="nav__primary__item -search"> <a class="nav__primary__trigger" data-nav="trigger" data-nav-search data-nav-target="nav-search" href="/search.aspx"><span class="a11y-sr-only">Search</span></a> <div class="nav__primary__dropdown" data-nav="target" id="nav-search"> <p data-module="label-float"> <label for="site-search"> <span class="nav-search__label--desktop">What are you searching for?</span> <span class="nav-search__label--mobile">Search</span> </label> <input type="search" id="site-search" value=""> <button class="fat-button"><span class="a11y-sr-only">Submit</span></button> </p> </div> </li> </ul> </nav> </header>    <main class="site-main" id="main-content" tabindex="-1"> <div id="panelMainContent"> <article dcrname ="iwDCR0_292113"> <header class="-padding--horizontal" itemscope itemtype="http://schema.org/ScholarlyArticle"> <div class="content-header content-container -width--wide -centered"> <div class="tags"> <ul class="tag__list"> <li class="tag__item"> <a class="tag__link" href="/cardiovascular/specialty.aspx?id=1002">Cardiovascular</a> </li> <li class="tag__item"> <a class="tag__link" href="/pulmonary/specialty.aspx?id=1012">Pulmonary and Critical Care</a> </li> <li class="tag__item"> <a class="tag__link" href="/cardiovascular/topic.aspx?id=1091">Thrombosis</a> </li> </ul> </div> <h1 class="content-header__heading" itemprop="name">Reducing Post-Thrombotic Syndrome Through Reperfusion After DVT May Be Time-Sensitive</h1> <div class="content-header__metadata"> <p class="content-metadata"> <span class="content-metadata__media -journal">Journal</span> <time class="date" datetime="2021-04-08" itemprop="datePublished">Published on April 8, 2021 </time> </p> <p data-module="share-links"> </p> <p class="citation"> Originally published on <cite itemprop="citation"><a href="https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.049096">Circulation</a></cite> </p> </div> </div> </header> <div class="-padding--vertical -padding--horizontal"> <div class="layout-columns -width--wide -centered"> <div class="layout-columns__main"> <div class="layout-columns__main__content"> <div class="content-summary"> <h3 class="content-summary__heading">Key findings</h3> <ul> <li>Randomized trials have demonstrated limited clinical benefit of adding catheter-based intervention to anticoagulation for managing acute proximal deep vein thrombosis (DVT), but those trials did not fully analyze the timing of the intervention to restore blood flow</li> <li>In a mouse model of DVT, early but not later restoration of blood flow reduced thrombus burden and vein wall fibrosis</li> <li>A post hoc analysis of the ATTRACT trial showed the greatest improvement in post-thrombotic syndrome quality-of-life scores when pharmacomechanical catheter-directed thrombolysis was administered 4–8 days after onset of DVT symptoms. No benefit was observed after day 9 or before day 3</li> <li>Future trials of pharmacomechanical thrombolysis for DVT should study the effect of time since symptom onset and the presence of blood flow through the DVT</li> </ul> </div> <p></p><div class="article__signup-container"> <div class="email-signup-inline__container -background--white"> <style> #email-signup-inline { /* 540px */ background-image: url(/assets/raw/email-signup/cardiovascular-sub-callout.jpg); } @media only screen and (-webkit-min-device-pixel-ratio: 2), only screen and (min--moz-device-pixel-ratio: 2), only screen and (-moz-min-device-pixel-ratio: 2), only screen and (-o-min-device-pixel-ratio: 2/1), only screen and (min-device-pixel-ratio: 2), only screen and (min-resolution: 192dpi), only screen and (min-resolution: 2dppx) { #email-signup-inline { /* 1080 width */ background-image: url(/assets/raw/email-signup/cardiovascular-sub-callout.jpg); } } </style> <div class="content-container -width--wide -centered email-signup-inline__wrapper" id="email-signup-inline"> <div class="email-signup-inline__logo"> <img alt="Massachusetts General Hospital " src="/assets/logos/logo-white.svg"> </div> </div> <div class="email-signup-inline"> <h3 class="email-signup-inline__heading">Subscribe to the latest updates from Cardiovascular Advances in Motion</h3> <p class="email-signup-inline__subheading"></p>  <meta http-equiv="Content-Type" content="text/html; charset=utf-8" /> <meta name="referrer" content="no-referrer-when-downgrade">  <script type="text/javascript" data-for="FA__DOMContentLoadedEventDispatch" src="https://massgeneral.tfaforms.net/js/FA__DOMContentLoadedEventDispatcher.js" defer></script> <script type="text/javascript"> document.addEventListener("FA__DOMContentLoaded", function(){ const FORM_TIME_START = Math.floor((new Date).getTime()/1000); let formElement = document.getElementById("tfa_0"); if (null === formElement) { formElement = document.getElementById("0"); } let appendJsTimerElement = function(){ let formTimeDiff = Math.floor((new Date).getTime()/1000) - FORM_TIME_START; let cumulatedTimeElement = document.getElementById("tfa_dbCumulatedTime"); if (null !== cumulatedTimeElement) { let cumulatedTime = parseInt(cumulatedTimeElement.value); if (null !== cumulatedTime && cumulatedTime > 0) { formTimeDiff += cumulatedTime; } } let jsTimeInput = document.createElement("input"); jsTimeInput.setAttribute("type", "hidden"); jsTimeInput.setAttribute("value", formTimeDiff.toString()); jsTimeInput.setAttribute("name", "tfa_dbElapsedJsTime"); jsTimeInput.setAttribute("id", "tfa_dbElapsedJsTime"); jsTimeInput.setAttribute("autocomplete", "off"); if (null !== formElement) { formElement.appendChild(jsTimeInput); } }; if (null !== formElement) { if(formElement.addEventListener){ formElement.addEventListener('submit', appendJsTimerElement, false); } else if(formElement.attachEvent){ formElement.attachEvent('onsubmit', appendJsTimerElement); } } }); </script> <link href="https://massgeneral.tfaforms.net/dist/form-builder/5.0.0/wforms-layout.css?v=20484c23150f9374e828ae7e95c879908749f33b" rel="stylesheet" type="text/css" /> <link href="https://massgeneral.tfaforms.net/uploads/themes/theme-7.css" rel="stylesheet" type="text/css" /> <link href="https://massgeneral.tfaforms.net/dist/form-builder/5.0.0/wforms-jsonly.css?v=20484c23150f9374e828ae7e95c879908749f33b" rel="alternate stylesheet" title="This stylesheet activated by javascript" type="text/css" /> <script type="text/javascript" src="https://massgeneral.tfaforms.net/wForms/3.11/js/wforms.js?v=20484c23150f9374e828ae7e95c879908749f33b"></script> <script type="text/javascript"> wFORMS.behaviors.prefill.skip = false; </script> <script type="text/javascript" src="https://massgeneral.tfaforms.net/wForms/3.11/js/localization-en_US.js?v=20484c23150f9374e828ae7e95c879908749f33b"></script>  <div class="wFormContainer" > <div class=""> <div class="wForm" id="526-WRPR" data-language="en_US" dir="ltr"> <div class="codesection" id="code-526"></div> <form method="post" action="https://massgeneral.tfaforms.net/api_v2/workflow/processor" class="hintsBelow labelsAbove" id="526"> <div class="oneField field-container-D " id="tfa_9-D"> <div aria-live="assertive"> <p class="marketo-signup__error"> Error: Please enter a valid email address. </p> </div> <p class="marketo-signup__input" data-module="label-float"> <label for="email-address"> Email Address </label> <input type="email" id="tfa_9" name="tfa_9" value="" data-marketo="email" > <button class="fat-button" type="submit" data-label="Submit" class="primaryAction" id="submit_button" value="Submit"> <span class="a11y-sr-only">Submit</span> </button> </p> <input type="hidden" id="tfa_10" name="tfa_10" value="Sub_Heart_Vascular" class=""><input type="hidden" id="tfa_12" name="tfa_12" value="AiM Sub Box" class=""> </div> <div style="clear:both"></div> <input type="hidden" value="526" name="tfa_dbFormId" id="tfa_dbFormId"> <input type="hidden" value="" name="tfa_dbResponseId" id="tfa_dbResponseId"> <input type="hidden" value="ef6d4cb40bdc8f1ec188e1cf0399daa6" name="tfa_dbControl" id="tfa_dbControl"> <input type="hidden" value="" name="tfa_dbWorkflowSessionUuid" id="tfa_dbWorkflowSessionUuid"> <input type="hidden" value="5" name="tfa_dbVersionId" id="tfa_dbVersionId"> <input type="hidden" value="" name="tfa_switchedoff" id="tfa_switchedoff"> </form> </div> </div> </div> <script id="open-telemetry-script" type="text/javascript" src="https://massgeneral.tfaforms.net/dist/open-telemetry/open-telemetry.152f594b0ae29ae89d4a.js" data-customer-id="1118" data-exporter-url="https://us-east-1-otel.formassembly.com/v1/traces" data-exporter-console="0" ></script> <script src="https://massgeneral.tfaforms.net/api_v2/sst/copy-and-paste"></script> </div> </div> </div> <p>Despite therapeutic anticoagulation, up to half of patients with proximal deep vein thrombosis (DVT) will develop post-thrombotic syndrome (PTS), a morbid illness characterized by limb swelling, heaviness and skin changes. The "open-vein hypothesis" holds that timely thrombus removal will reduce complications such as vein wall injury, valvular reflux and venous hypertension, features underlying PTS.</p> <p>However, three phase 3 randomized trials have demonstrated limited clinical PTS benefit when adding catheter-based intervention to anticoagulation. These studies did not fully analyze the timing of catheter intervention, though.</p> <p>In <em><a href="https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.049096" target="_blank" rel="noopener noreferrer">Circulation</a></em>, <a href="https://advances.massgeneral.org/contributors/contributor.aspx?id=1003" target="_blank" rel="noopener noreferrer">Farouc Jaffer, MD, PhD</a>, investigator in the Cardiovascular Research Center and director of the <a href="https://www.massgeneral.org/heartcenter/services/treatmentprograms.aspx?id=1004" target="_blank" rel="noopener noreferrer">Coronary Intervention </a>and the <a href="https://www.massgeneral.org/heartcenter/services/procedure.aspx?id=2308" target="_blank" rel="noopener noreferrer">Chronic Total Occlusion Percutaneous Coronary Intervention Program</a> at Massachusetts General Hospital, <a href="https://advances.massgeneral.org/contributors/contributor.aspx?id=2025">Wenzhu Li, MD</a>, postdoctoral fellow in the <a href="https://www.massgeneral.org/heart-center/research-and-clinical-trials/jaffer-lab" target="_blank" rel="noopener noreferrer">Jaffer Lab</a>, and colleagues published experimental and clinical evidence that the outcomes for reducing the PTS after catheter-based thrombus removal in patients with acute proximal DVT may depend on the time since symptom onset.</p> <h2>Pre-clinical Study</h2> <p>The researchers created a mouse model of DVT by completely ligating the inferior vena cava. They then mechanically de-ligated the vessel to promote restored blood flow (RBF). Some animals also received recombinant tissue plasminogen activator (rtPA) two days after de-ligation.</p> <p>The results demonstrated a time-dependent benefit of RBF:</p> <ul> <li>Mice that showed RBF by day 4 exhibited a significant reduction in thrombus burden and vein wall fibrosis at day 8</li> <li>Differences in DVT resolution between RBF+ and RBF− mice were not present at day 4 but evolved in a crucial time window between day 4 and day 8</li> <li>Thrombus reduction and its benefits did not occur if RBF was achieved late, by day 6 or day 8</li> <li>rtPA administered at day 4 improved DVT resolution, but only for occlusive thrombi without existing RBF</li> <li>rtPA administered at day 6 did not further improve DVT resolution</li> </ul> <h2>Reanalysis of the ATTRACT Trial</h2> <p>To assess the clinical relevance of the animal findings, the team reanalyzed data from the two-year randomized, phase 3 ATTRACT trial. Published in 2017 in <em><a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1615066" target="_blank" rel="noopener noreferrer">The New England Journal of Medicine</a></em>, it showed that pharmacomechanical catheter-directed thrombolysis (PCDT) for patients with acute proximal DVT did not reduce the risk of post-thrombotic syndrome or improve long-term Venous Insufficiency Epidemiological and Economic Study Quality-of-Life (QoL) scores beyond anticoagulation alone.</p> <p>For the new analysis, the researchers categorized the 691 ATTRACT patients according to the time from symptom onset to randomization:</p> <ul> <li><strong>Early:</strong> 0–3 days</li> <li><strong>Intermediate:</strong> 4–8 days</li> <li><strong>Late:</strong> 9–14 days</li> </ul> <h2>Results of the Reanalysis</h2> <ul> <li>In the intermediate group, PCDT was associated with improved QoL scores at every follow-up visit compared with anticoagulation alone (P≤0.002)</li> <li>PCDT was not associated with significantly improved QoL scores in the early or late group</li> <li>Villalta scores, which reflect the presence of post-thrombotic syndrome and its severity, were also best in the intermediate group, but the interaction between treatment assignment (PCDT vs. anticoagulation) and timing of treatment was not statistically significant</li> </ul> <h2>The Way Forward</h2> <p>Because of the latter finding, the results of the new analysis should be considered hypothesis-generating only. Future trials of PCDT for DVT should incorporate a three-timeframe approach. For example:</p> <p><strong>Early group:</strong> Administer anticoagulation alone initially; use ultrasound on day 3–4 after DVT symptom onset to assess for RBF.</p> <ul> <li>If spontaneous RBF is present, continue anticoagulation alone</li> <li>If blood flow is absent, consider patients for PCDT as soon as possible</li> </ul> <p><strong>Intermediate group:</strong> Perform ultrasound at presentation to assess for RBF, then proceed as above.</p> <p><strong>Late group: </strong>Prescribe anticoagulation alone, given the lack of benefit of PCDT observed in the late group in this analysis.</p> <p></p> <p></p> <p></p> <p></p><p class="fat-link__wrapper u-text-right"> <a class="fat-link -caret -large" href="https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.049096">view original journal article <em>Subscription may be required</em></a> </p> <div class="article-attribution" itemscope itemtype="http://schema.org/ScholarlyArticle"> <p class="article-attribution__logo" itemscope itemtype="http://schema.org/Periodical"> <a href="https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.049096"> <span class="a11y-sr-only" itemprop="name">Circulation</span> </a> </p> <p class="article-attribution__metadata" itemscope itemtype="http://schema.org/PublicationIssue"> <span> Journal Article Published: <time datetime="2021-01-15" itemprop="datePublished">January 15, 2021</time> </span> </p> </div> <p class="cta">Learn more about <a href="https://www.massgeneral.org/heart-center/research-and-clinical-trials/jaffer-lab">Dr. Jaffer's laboratory in the Cardiovascular Research Center</a></p> <p class="cta">Refer a patient to the <a href="https://www.massgeneral.org/heart-center/appointments-and-referrals/referrals">Corrigan Minehan Heart Center</a></p> </div> </div> <aside class="layout-columns__sidebar -article__contributors"> <div class="layout-columns__sidebar__content"> <div class="profile-compact__wrapper"> <p class="u-no-margin"> <strong>Contributors</strong> </p> <div class="profile -compact" itemscope itemtype="http://schema.org/Person"> <div class="profile__content"> <h3 class="profile__name" itemprop="name"> <a href="/contributors/contributor.aspx?id=1003" itemprop="url">Farouc A. Jaffer, MD, PhD ›</a></h3><p class="profile__title" itemprop="jobTitle">Director, Coronary Intervention, Massachusetts General Hospital, Director, MGH Chronic Total Occlusion (CTO) Percutaneous Coronary Intervention (PCI) program, Associate Physician, MGH Cardiology, Department of Medicine</p> </div> <p class="profile__image"> <img alt="" itemprop="image" srcset="/assets/images/contributors/Jaffer_Farouc_17298_advances.png, /assets/images/contributors/Jaffer_Farouc_17298_advances_2x.png 2x" src="/assets/images/contributors/Jaffer_Farouc_17298_advances.png"> </p> </div> <div class="profile -compact" itemscope itemtype="http://schema.org/Person"> <div class="profile__content"> <h3 class="profile__name" itemprop="name"> <a href="/contributors/contributor.aspx?id=2025" itemprop="url">Wenzhu Li, MD ›</a></h3><p class="profile__title" itemprop="jobTitle">Postdoctoral Fellow, Jaffer Lab, Massachusetts General Hospital</p> </div> </div> </div> </div> </aside> <section class="topics-layout -article__related"> <div class="topics-layout__inner"> <div class="topics-layout__sidebar"> <h2 class="section-heading">Related topics</h2> </div> <div class="topics-layout__main"> <ul class="topics-list" data-module="topics-list"> <li><a href="/cardiovascular/topic.aspx?id=1091">Thrombosis</a></li> </ul> </div> </div> </section> <section class="-padding--horizontal -padding--vertical -article__related"> <div class="layout-columns -width--wide -centered"> <div class="layout-columns__pod--half"> <div class="content-tease" itemscope itemtype="http://schema.org/ScholarlyArticle"> <p class="content-tease__topic"> <span class="highlight">Related</span> </p> <h3 class="content-tease__heading" itemprop="name"> <a href="/cardiovascular/article.aspx?id=1362" itemprop="url">Interventional Cardiology Studies Boost Safety in TAVR, PCI</a> </h3> <p itemprop="description"> <p>A Massachusetts General Hospital interventional cardiologist is using research to lower bleeding risk and incidence of stroke in percutaneous coronary intervention and transcatheter aortic valve replacement.</p></p> <p class="content-tease__related"> <a href="/cardiovascular/topic.aspx?id=1036" itemprop="relatedLink">Cardiac Surgery</a>, <a href="/cardiovascular/specialty.aspx?id=1002" itemprop="relatedLink">Cardiovascular</a>, <a href="/cardiovascular/topic.aspx?id=1002" itemprop="relatedLink">Coronary Artery Disease</a>, <a href="/cardiovascular/topic.aspx?id=1083" itemprop="relatedLink">Interventional Cardiology</a>, <a href="/cardiovascular/topic.aspx?id=1091" itemprop="relatedLink">Thrombosis</a>, <a href="/cardiovascular/topic.aspx?id=1046" itemprop="relatedLink">Vascular Surgery</a> </p> <p class="content-metadata"> <span class="content-metadata__media -article">Article</span> <time class="date" datetime="2021-03-05" itemprop="datePublished">March 5, 2021</time> </p> </div> </div> <div class="layout-columns__pod--half"> <div class="content-tease" itemscope itemtype="http://schema.org/ScholarlyArticle"> <p class="content-tease__topic"> <span class="highlight">Related</span> </p> <h3 class="content-tease__heading" itemprop="name"> <a href="/cardiovascular/journal.aspx?id=1881" itemprop="url">Thrombotic Events Not Uncommon in Non–COVID-19 Viral Pneumonia</a> </h3> <p itemprop="description"> <p>Researchers in the Corrigan Minehan Heart Center at Massachusetts General Hospital, and colleagues found that even in the pre–COVID-19 era, 3% of patients hospitalized for viral pneumonia had acute thrombotic complications.</p></p> <p class="content-tease__related"> <a href="/cardiovascular/specialty.aspx?id=1002" itemprop="relatedLink">Cardiovascular</a>, <a href="/research-and-innovation/topic.aspx?id=1056" itemprop="relatedLink">COVID-19</a>, <a href="/pulmonary/specialty.aspx?id=1012" itemprop="relatedLink">Pulmonary and Critical Care</a>, <a href="/cardiovascular/topic.aspx?id=1091" itemprop="relatedLink">Thrombosis</a> </p> <p class="content-metadata"> <span class="content-metadata__media -journal">Journal</span> <time class="date" datetime="2021-03-22" itemprop="datePublished">March 22, 2021</time> </p> </div> </div> </div> </section> </div> </div> </article> </div> </main>  <footer class="site-footer"> <div class="-padding--horizontal"> <nav aria-label="Footer links" class="content-container -width--wide -centered -padding--bottom"> <ul class="footer__nav" role="presentation"> <li> <a href="https://www.massgeneral.org/about">About Mass General</a> </li> <li> <a href="https://www.massgeneral.org/about/support">Giving</a> </li> <li> <a href="https://www.massgeneral.org/news/">News</a> </li> <li> <a href="https://www.massgeneral.org/notices/terms-of-use">Terms of Use</a> </li> <li> <a href="/contact-us.aspx">Contact Us</a> </li> </ul> </nav> <div class="content-container -width--wide -centered -padding--bottom"> <p class="u-text-centered"> <a class="footer__logo" href="http://www.massgeneral.org"> <img alt="MGH" src="/assets/images/logo-color.svg"> <span class="a11y-sr-only">Massachusetts General Hospital</span> </a> </p> <ul class="footer__social" role="presentation"> <li> <a href="https://twitter.com/MassGeneralNews"> <svg width="19" height="15" xmlns=http://www.w3.org/2000/svg viewBox="0 0 18.81 17"><path d="m14.81,0h2.89l-6.3,7.2,7.41,9.8h-5.8l-4.55-5.94-5.2,5.94H.37l6.74-7.7L0,0h5.95l4.11,5.43L14.81,0Zm-1.01,15.28h1.6L5.08,1.63h-1.72l10.43,13.64Z"/></svg> </a> </li> <li> <a href="https://www.facebook.com/massgeneral/"> <svg xmlns="http://www.w3.org/2000/svg" width="9" height="19"><path fill-rule="evenodd" fill="#007EA3" d="M0 6.284h1.929V4.373c0-.84.021-2.139.621-2.943C3.182.578 4.05 0 5.543 0 7.975 0 9 .353 9 .353l-.482 2.911s-.804-.237-1.554-.237-1.421.273-1.421 1.037V6.284h3.075l-.215 2.841h-2.86V19H1.929V9.125H0V6.284z"/></svg> </a> </li> <li> <a href="http://www.youtube.com/user/MassGeneralHospital"> <svg xmlns="http://www.w3.org/2000/svg" width="23" height="17"><path fill-rule="evenodd" fill="#007EA3" d="M22.77 13.325s-.224 1.666-.914 2.399c-.875.963-1.855.968-2.305 1.024-3.218.244-8.051.252-8.051.252s-5.98-.057-7.82-.243c-.512-.101-1.661-.07-2.536-1.033-.69-.733-.914-2.399-.914-2.399S0 11.369 0 9.413V7.579c0-1.956.23-3.912.23-3.912s.224-1.665.914-2.399C2.019.306 2.999.301 3.448.244 6.667 0 11.495 0 11.495 0h.01s4.828 0 8.046.244c.45.057 1.43.062 2.305 1.024.69.734.914 2.399.914 2.399S23 5.623 23 7.579v1.834c0 1.956-.23 3.912-.23 3.912zm-8.519-4.481L9.124 5.246l.001 6.389 5.126-2.791zm-5.127-4v.358l5.887 3.228.328-.179-6.215-3.407z"/></svg> </a> </li> <li> <a href="https://www.linkedin.com/company/massachusetts-general-hospital"> <svg xmlns="http://www.w3.org/2000/svg" width="18" height="18"><path fill-rule="evenodd" fill="#007EA3" d="M14.273 18v-5.846c0-1.396-.027-3.188-1.939-3.188-1.94 0-2.236 1.518-2.236 3.085V18H6.371V5.977h3.575v1.642h.052c.498-.945 1.715-1.941 3.53-1.941 3.775 0 4.472 2.49 4.472 5.728V18h-3.727zM2.164 4.333A2.164 2.164 0 0 1 0 2.166a2.164 2.164 0 1 1 4.327 0 2.166 2.166 0 0 1-2.163 2.167zM4.031 18H.296V5.977h3.735V18z"/></svg> </a> </li> <li> <a href="https://www.doximity.com/pages/hospitals/ma/boston/massachusetts-general-hospital"> <svg xmlns="http://www.w3.org/2000/svg" width="17.583" height="18" viewBox="8.024 95.826 17.583 18"><g fill="#007EA3"><path d="M23.207 104.657c.034-.062.02-.115.02-.168v-5.142c0-.413.173-.586.58-.586h1.278c.34 0 .523.178.523.52v13.803c0 .332-.178.52-.51.52-.45.004-.9.004-1.353 0-.32 0-.513-.197-.513-.52v-1.368c-.062.03-.087.077-.115.12-.442.614-.965 1.138-1.632 1.498-.788.427-1.637.557-2.52.46-1.215-.13-2.232-.657-3.068-1.545-.725-.772-1.152-1.7-1.334-2.736-.207-1.147-.163-2.29.22-3.398.65-1.853 1.925-3.024 3.874-3.36 1.642-.288 3.058.197 4.176 1.464.13.134.245.283.374.437zm-3.216 7.137c1.13-.02 1.978-.47 2.597-1.334.658-.917.812-1.95.605-3.043-.302-1.58-1.59-2.81-3.35-2.698-.96.06-1.766.464-2.3 1.266-.9 1.354-.945 2.793-.182 4.214.557 1.047 1.494 1.566 2.63 1.594zM15.988 95.835c.355-.024.71.004 1.06.042.04.005.078.01.116.024.144.054.226.184.207.333-.023.144-.143.163-.258.173-.624.053-1.23.177-1.82.394-.993.365-1.885.902-2.71 1.555-1.1.864-2.056 1.862-2.81 3.048-.522.82-.93 1.69-1.118 2.65-.02.104-.033.215-.058.32-.024.107-.052.208-.187.227-.13.014-.265-.062-.317-.187-.053-.13-.053-.27-.058-.404-.058-1.244.12-2.45.605-3.6.33-.783.796-1.48 1.368-2.108 1.277-1.412 2.894-2.155 4.76-2.41.203-.03.41-.053.615-.062.202 0 .403.005.605.005zM11.342 105.18c.014-1.512.494-2.842 1.53-3.96.84-.907 1.883-1.44 3.083-1.69.687-.144 1.383-.168 2.08-.1l.104.013c.143.03.24.125.23.24-.015.148-.145.144-.25.163-.173.024-.35.04-.52.072-.916.178-1.727.586-2.48 1.124-.918.658-1.71 1.435-2.343 2.37-.485.716-.854 1.48-.984 2.344-.015.105-.024.23-.178.23-.14 0-.216-.09-.24-.26-.04-.176-.028-.364-.033-.546z"/></g></svg> </a> </li> </ul> <p class="footer__address"> <a href="https://www.google.com/maps/dir/''/55+Fruit+St,+Boston,+MA+02114/@42.3631581,-71.0710274,17z/data=!3m1!4b1!4m8!4m7!1m0!1m5!1m1!1s0x89e370999524529b:0x10e737717f2daf80!2m2!1d-71.0688334!2d42.3631542" itemprop="address" itemscope itemtype="http://schema.org/PostalAddress"> <span itemprop="streetAddress">55 Fruit Street</span> <span itemprop="addressLocality">Boston</span>, <span itemprop="addressRegion">MA</span> <span itemprop="postalCode">02114</span> </a> <span class="footer__phone"> Phone: <a href="tel:6177262000" itemprop="telephone">617-726-2000</a> </span> </p> <p> Copyright © 2007-2024. The General Hospital Corporation. All Rights Reserved. </p> </div> </div> <div class="content-container -padding--horizontal -padding--vertical -background--grey"> <ul class="footer__partners -width--wide -centered" role="presentation"> <li> <a href="https://www.massgeneral.org/education/about"> <img alt="Harvard teaching hospital logo" src="/assets/images/logo-hms.svg" width="170"> </a> </li> <li> <a href="https://www.massgeneralbrigham.org/"> <img alt="Mass General Brigham logo" src="/assets/images/MassGeneralBrigham-grey.svg" width="200"> </a> </li> <li> <a href="https://www.massgeneral.org/about/leadership"> <img alt="Physicians" src="/assets/images/logo-physicians.svg" width="177"> </a> </li> <li> <a href="http://protomag.com/"> <img alt="Proto Magazine Logo" src="/assets/images/logo-proto.svg" width="117"> </a> </li> </ul> </div> </footer> <script src="/assets/scripts/index.js"></script>  </body> </html>