CAVA (Ultrasound-accelerated catheter-directed thrombolysis on preventing post-thrombotic syndrome) trial: Long-term follow-up results

Pascale Notten, André A. E. A. de Smet, Lidwine W. Tick, Marlène H. W. van de Poel, Otmar R. M. Wikkeling, Louis-Jean Vleming, Ad Koster, Kon-Siong G. Jie, Esther M. G. Jacobs, Harm P. Ebben, Michiel Coppens, Hugo ten Cate, Cees H. A. Wittens, Arina J. ten Cate-Hoek

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BACKGROUND: The CAVA (Ultrasound-Accelerated Catheter-Directed Thrombolysis Versus Anticoagulation for the Prevention of Post-Thrombotic Syndrome) trial did not show a reduction of post-thrombotic syndrome (PTS) after additional ultrasound-accelerated catheter-directed thrombolysis in patients with acute iliofemoral deep vein thrombosis at 1-year follow-up. This prespecified analysis of the CAVA trial aimed to determine the impact of additional thrombolysis on outcomes of PTS at long-term follow-up. METHODS AND RESULTS: Patients aged 18 to 85 years with a first-time acute iliofemoral deep vein thrombosis were included and randomly assigned (1:1) to either standard treatment plus ultrasound-accelerated catheter-directed thrombolysis or standard treatment alone. The primary outcome was the proportion of PTS (Villalta score ≥5 on 2 occasions ≥3 months apart or venous ulceration) at the final follow-up visit. Additionally, PTS according to the International Society on Thrombosis and Haemostasis (ISTH) consensus definition was assessed to allow external comparability. Major bleedings were the main safety outcome. At a median follow-up of 39.0 months (interquartile range, 23.3–63.8), 120 patients (79.8%) participated in the final follow-up visit: 62 from the intervention group and 58 from the standard treatment group. PTS developed in 19 (30.6%) versus 26 (44.8%) patients, respectively (odds ratio [OR], 0.54; 95% CI, 0.26 to 1.15 [P=0.11]), with an absolute difference between groups of −14.2% (95% CI, −32.0% to 4.8%). Using the ISTH consensus definition, a significant reduction in PTS was observed (29 [46.8%] versus 40 [69.0%]) (OR, 0.40; 95% CI, 0.19–0.84 [P=0.01]) with an absolute difference between groups of −22.2% (95% CI, −39.8% to −2.8%). No new major bleedings occurred following the 12-month follow-up. CONCLUSIONS: The impact of additional ultrasound-accelerated catheter-directed thrombolysis on the prevention of PTS was found to increase with time. Although this study was limited by its sample size, the overall findings indicate a reduction of mild PTS without impact on quality of life.
Original languageEnglish
Article numbere018973
JournalJournal of the American Heart Association
Issue number11
Publication statusPublished - 2021


  • Catheter-directed thrombolysis
  • Iliofemoral deep vein thrombosis
  • Long-term follow-up
  • Post-thrombotic syndrome
  • Quality of life

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