Endovenous therapy for deep venous thrombosis: the TORPEDO trial.
OBJECTIVE
We compared the efficacy and safety of percutaneous endovenous intervention (PEVI) plus anticoagulation with anticoagulation alone in the reduction of venous thromboembolism (VTE) and post-thrombotic syndrome (PTS) in acute proximal deep venous thrombosis (DVT).


BACKGROUND
Recurrent VTE and PTS are common complications of DVT. There are no randomized trials investigating the efficacy of PEVI in the reduction of the above complications.


METHODS
Patients with symptomatic proximal DVT were randomized to receive PEVI plus anticoagulation or anticoagulation alone. Anticoagulation consisted of intravenous unfractionated heparin or subcutaneous low-molecular weight heparin plus warfarin. PEVI consisted of one or more of a combination of thrombectomy, balloon venoplasty, stenting, or local low-dose thrombolytic therapy.


RESULTS
At 6 months follow-up, recurrent VTE developed in 2 of 88 patients of the PEVI plus anticoagulation group versus 12 of 81of the anticoagulation-alone group (2.3% vs. 14.8%, P = 0.003). PTS developed in 3 of 88 patients of the PEVI plus anticoagulation Group and 22 of 81 of the anticoagulation-alone group (3.4% vs. 27.2%, P < 0.001).


CONCLUSIONS
In patients with symptomatic proximal DVT, PEVI plus anticoagulation may be superior to anticoagulation-alone in the reduction of VTE and PTS at 6 months.
Sharifi
Mohsen
M
Arizona Cardiovascular Consultants, Mesa, AZ, USA. seyedmohsensharifi@yahoo.com
Mehdipour
Mahshid
M
Bay
Curt
C
Smith
Gary
G
Sharifi
Jalaladdin
J
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D001130:Arizona; D018572:Disease-Free Survival; D004359:Drug Therapy, Combination; D057510:Endovascular Procedures / Q000009:adverse effects; D005260:Female; D006493:Heparin / Q000627:therapeutic use*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D054070:Postthrombotic Syndrome / Q000209:etiology / Q000517:prevention & control*; D012008:Recurrence; D015607:Stents; D013396:Suction; D017131:Thrombectomy; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D020246:Venous Thrombosis / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D014859:Warfarin / Q000627:therapeutic use*
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin; D006493:Heparin