O'Sullivan Gerard J, de Graaf Rick, Black Steven A
Galway University Hospitals, Galway, Ireland.
Radiology and Interventional Radiology, Clinical Center of Friedrichshafen, Friedrichshafen, Germany.
Cardiovasc Intervent Radiol. 2018 Sep;41(9):1313-1317. doi: 10.1007/s00270-018-2016-y. Epub 2018 Jun 26.
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.
静脉血栓栓塞症（VTE）是一个重大的公共卫生问题；深静脉血栓形成（DVT）影响约千分之一的患者。在西欧，每年VTE导致的死亡人数比乳腺癌、前列腺癌、获得性免疫缺陷综合征（AIDS）和道路交通事故导致的死亡人数总和还多，约37万欧洲公民因此死亡（Cohen等人，《血栓与止血》98:756 - 764，2007年；Bĕlohlávek等人，《实验与临床心脏病学》18(2):129 - 138，2013年）。最近发表的ATTRACT试验（急性静脉血栓形成导管辅助溶栓取栓试验）（Vedantham等人，《新英格兰医学杂志》377:2240 - 2252，2017年）得出结论，在标准抗凝治疗和使用弹力袜的基础上加用导管定向溶栓，在降低2年后血栓后综合征（PTS）发生率方面，相较于标准治疗并无显著临床益处。这是规模最大的前瞻性多中心随机对照试验（RCT），代表了长达十年的规划、实施和分析的成果。在这篇观点文章中，我们分析了为何需要该试验、它证明了什么、存在哪些局限性，以及这一重要出版物将引领我们走向何方。
