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Just How Attractive is the ATTRACT Trial?

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Abstract

Venous thromboembolism (VTE) is a major public health issue; deep vein thrombosis (DVT) affects about 1/1000 patients. Each year, VTE kills more patients in Western Europe than breast cancer, prostate cancer, acquired immune deficiency syndrome (AIDS) and road traffic accidents combined and is responsible for the deaths of approximately 370,000 European citizens (Cohen et al. in Thromb Haemost 98:756–764, 2007; Bĕlohlávek et al. in Exp Clin Cardiol 18(2):129–138, 2013). The recently published ATTRACT trial (Acute Venous Thrombosis Thrombus Removal with Adjunctive Catheter-directed Thrombolysis) (Vedantham et al. in N Engl J Med 377:2240–2252, 2017) concluded that the addition of catheter-directed thrombolysis to standard therapy with anticoagulation and compression stockings offers no significant clinical benefit over standard therapy in terms of reduction in the rate of post-thrombotic syndrome (PTS) at 2 years. It is the largest, prospective, multi-centre, randomised controlled trial (RCT) and represents the culmination over a decade of planning, execution and analysis. In this opinion article, we analyse why it was needed, what it demonstrated, some limitations, and the directions in which this important publication will take us.

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Authors and Affiliations

  1. Galway University Hospitals, Galway, Ireland

    Gerard J. O’Sullivan

  2. Radiology and Interventional Radiology, Clinical Center of Friedrichshafen, Friedrichshafen, Germany

    Rick de Graaf

  3. Venous and Lymphatic Surgery, Guys and St. Thomas Hospital, Westminster Bridge Road, London, UK

    Steven A. Black

Authors
  1. Gerard J. O’Sullivan
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  2. Rick de Graaf
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  3. Steven A. Black
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Corresponding author

Correspondence to Gerard J. O’Sullivan.

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Conflict of interest

In the ATTRACT trial, two devices were used, Trellis (Medtronic, Galway, Ireland) and AngioJet (Boston Scientific, Galway, Ireland). Within the past 24 months, each of the authors has served on a paid Scientific Advisory Board, or been on a paid speaker panel for one or other of these two companies. None of these were in any way related to the ATTRACT trial. We can confirm that the above have made no difference whatsoever to our submission; especially the Trellis device is no longer commercially available, and the AngioJet device used in the trial is no longer the primary thrombectomy device available from Boston Scientific.

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O’Sullivan, G.J., de Graaf, R. & Black, S.A. Just How Attractive is the ATTRACT Trial?. Cardiovasc Intervent Radiol 41, 1313–1317 (2018). https://doi.org/10.1007/s00270-018-2016-y

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  • DOI: https://doi.org/10.1007/s00270-018-2016-y

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