Ultrasound-enhanced Thrombolysis Versus Standard Catheter Directed Thrombolysis for Ilio-femoral Deep Vein Thrombosis (BERNUTIFUL)

This study is ongoing, but not recruiting participants.
Sponsor:
Information provided by:
University Hospital Inselspital, Berne
ClinicalTrials.gov Identifier:
NCT01482273
First received: November 28, 2011
Last updated: January 20, 2014
Last verified: January 2014
  Purpose

Patients with deep vein thrombosis (DVT) of the ilio-femoral veins have increased risk for developing post-thrombotic syndrome (PTS) and recurrent venous thromboembolism compared to more distal DVT. There's evidence that the early removal of the obstructing thrombus by catheter directed thrombolysis (CDT) reduces the risk of developing a PTS, and a higher degree of thrombolysis is associated with lower incidence of PTS, better quality of life and lower risk of recurrent venous thromboembolism. A further development is ultrasound-enhanced thrombolysis combining CDT with a sophisticated catheter system that employs high-frequency, low-dose ultrasound. In vitro experiments showed that adding ultrasound to thrombolytic drugs accelerates thrombolysis while Ultrasound exposure alone results in no thrombolysis, however the superiority of ultrasound-enhanced thrombolysis over standard CDT has never been formally assessed in vivo. The hypothesis for this study is that ultrasound-enhanced thrombolysis reaches a higher degree of thrombolysis than standard CDT in patients with symptomatic ilio-femoral DVT.


Condition Intervention
Venous Thrombosis
Postthrombotic Syndrome
Procedure: CDT+US group
Procedure: CDT-US group

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Single Blind (Outcomes Assessor)
Primary Purpose: Treatment
Official Title: The BERN Ultrasound-enhanced Thrombolysis for Ilio-Femoral Deep Vein Thrombosis versUs Standard Catheter Directed thromboLysis Trial (BERNUTIFUL-Trial)

Resource links provided by NLM:


Further study details as provided by University Hospital Inselspital, Berne:

Primary Outcome Measures:
  • Improvement of Total EKOS Thrombus Score, a specifically developed venographic scoring system [ Time Frame: After 15 hours of CDT ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Improvement of the "Venous Registry Index" venographic scoring system [ Time Frame: After 15 hours of CDT ] [ Designated as safety issue: No ]
  • Early symptom relief assessed by standardized limb circumference measurements and validated visual analogue pain scale [ Time Frame: During and after 15 hours of CDT ] [ Designated as safety issue: No ]
  • Treatment related complications [ Time Frame: 30 days ] [ Designated as safety issue: Yes ]
  • Development of PTS assessed by Villalta scale and Quality of life (CIVIQ) [ Time Frame: After 12 months ] [ Designated as safety issue: No ]
  • Venous valve patency/insufficiency assessed by duplex sonography [ Time Frame: After 12 months ] [ Designated as safety issue: No ]

Estimated Enrollment: 48
Study Start Date: November 2011
Estimated Study Completion Date: December 2014
Primary Completion Date: November 2013 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Active Comparator: CDT+US group
CDT using the EkoSonic Endovascular System with intravascular high-frequency, low-power ultrasound for 15 hours.
Procedure: CDT+US group
CDT using the EkoSonic Endovascular System with intravascular high-frequency, low-power ultrasound for 15 hours.
Active Comparator: CDT-US group
CDT using the EkoSonic Endovascular System without intravascular high-frequency, low-power ultrasound for 15 hours.
Procedure: CDT-US group
CDT using the EkoSonic Endovascular System without intravascular high-frequency, low-power ultrasound for 15 hours.

Detailed Description:

Background

Deep vein thrombosis (DVT) is a public health problem with an annual incidence of 1 per 1000. Besides the acute risk of potentially fatal pulmonary embolism or phlegmasia cerulea dolens, these patients are at increased risk of recurrent venous thromboembolism, and in the long term 20-40% of them develop a post-thrombotic syndrome (PTS). PTS mainly develops in patients with DVT affecting the ilio-femoral veins, adversely affects the quality of life and causes important health care costs to the society. There's evidence that the early removal of the obstructing thrombus reduces the risk of developing a PTS, and a higher degree of thrombolysis is associated with lower incidence of PTS, better quality of life and lower risk of recurrent venous thromboembolism. Therefore, in addition to standard anticoagulation therapy, the latest international guidelines recommend catheter-directed thrombolysis (CDT) as first-line treatment for patients with ilio-femoral DVT and low bleeding risk. CDT refers to the infusion of thrombolytic drugs directly into the thrombus via a multisidehole catheter which is embedded in the thrombus using imaging guidance. A further development is ultrasound-enhanced thrombolysis combining CDT with a sophisticated catheter system that employs high-frequency, low-dose ultrasound. In vitro experiments showed that adding Ultrasound to thrombolytic drugs accelerates thrombolysis while Ultrasound exposure alone results in no thrombolysis. Although ultrasound-enhanced thrombolysis is now widely used to treat ilio-femoral DVT or high-risk pulmonary embolism, it is currently not known if this technique is superior to standard CDT.

Objective

To determine if the addition of intravascular high-frequency/low-dose ultrasound to standard CDT increases the percentage of clot lysis compared to CDT alone after treatment duration of 15 hours in patients with symptomatic ilio-femoral DVT and low bleeding risk

Methods

Study design: open-label (with blinding of data-analyzing physicians), randomized, controlled, single center clinical trial with a follow-up period of 12 months.

Subjects: total of 20 patients (10 in each study group) of 18-75 years of age with acute, symptomatic, objectively confirmed ilio-femoral DVT and a low bleeding risk.

Intervention: CDT using the EkoSonic Endovascular System with (CDT+US group) or without (CDT-US group) intravascular high-frequency, low-power ultrasound for 15 hours.

  Eligibility

Ages Eligible for Study:   18 Years to 75 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Symptomatic proximal DVT involving the iliac and/or common femoral vein, confirmed by Duplex Sonography, Angio-CT, Angio-MRI or Phlebography
  • Written informed consent

Exclusion Criteria

  • Age less than 18 years or greater than 75 years
  • Symptom duration > 14 days for the DVT episode in the index leg (i.e., non-acute DVT).
  • In the index leg: established post-thrombotic syndrome (PTS) or previous symptomatic DVT within the last 2 years.
  • Limb-threatening circulatory compromise.
  • PE with hemodynamic compromise (i.e., hypotension).
  • Inability to tolerate catheter procedure due to severe dyspnea or acute systemic illness.
  • Allergy, hypersensitivity, or thrombocytopenia from heparin, r-tPA, or iodinated contrast, except for mild-moderate contrast allergies for which steroid pre-medication can be used.
  • Known significant bleeding risk, or known coagulation disorder (including vitamin K antagonists with INR > 2.0 and platelet count < 100 000/mm3)
  • Severe renal impairment (estimated GFR < 30 ml/min).
  • Active bleeding, recent (< 3 mo) GI bleeding, severe liver dysfunction, bleeding diathesis.
  • Recent (< 3 mo) internal eye surgery or hemorrhagic retinopathy; recent (< 10 days) major surgery, cataract surgery, trauma, CPR, obstetrical delivery, or other invasive procedure.
  • History of stroke or intracranial/intraspinal bleed, tumor, vascular malformation, aneurysm.
  • Severe hypertension on repeated readings (systolic > 180 mmHg or diastolic > 105 mmHg).
  • Pregnant, lactation or parturition within the previous 30 days (positive pregnancy test, women of childbearing age must be tested or use a medically accepted method of birth control).
  • Recently (< 1 mo) had thrombolysis.
  • Life expectancy < 6 months or chronic non-ambulatory status.
  • Participating in any other investigational drug or device study or previous enrollment in this study
  • Inability to provide informed consent or to comply with study assessments (e.g. due to cognitive impairment or geographic distance).
  • Any other condition that the investigator feels would place the patient at increased risk if the investigational therapy is initiated
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01482273

Locations
Switzerland
Division of Clinical and Interventional Angiology, Swiss Cardiovascular Center, University Hospital and University of Bern
Bern, Switzerland, 3010
Sponsors and Collaborators
University Hospital Inselspital, Berne
Investigators
Principal Investigator: Nils Kucher, MD Division of Clinical and Interventional Angiology, Swiss Cardiovascular Center, University Hospital and University of Bern
Study Director: Torsten Willenberg, MD Division of Clinical and Interventional Angiology, Swiss Cardiovascular Center, University Hospital and University of Bern
Study Director: Iris Baumgartner, MD Division of Clinical and Interventional Angiology, Swiss Cardiovascular Center, University Hospital and University of Bern
Study Director: Rolf P Engelberger, MD Division of Clinical and Interventional Angiology, Swiss Cardiovascular Center, University Hospital and University of Bern
  More Information

Publications:
Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ, Jenkins JS, Kline JA, Michaels AD, Thistlethwaite P, Vedantham S, White RJ, Zierler BK; American Heart Association Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; American Heart Association Council on Peripheral Vascular Disease; American Heart Association Council on Arteriosclerosis, Thrombosis and Vascular Biology. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation. 2011 Apr 26;123(16):1788-830. doi: 10.1161/CIR.0b013e318214914f. Epub 2011 Mar 21. Erratum in: Circulation. 2012 Aug 14;126(7):e104. Circulation. 2012 Mar 20;125(11):e495.

Responsible Party: Nils Kucher, Division of Clinical and Interventional Angiology, Swiss Cardiovascular Center, University Hospital and University of Bern
ClinicalTrials.gov Identifier: NCT01482273     History of Changes
Other Study ID Numbers: 150/11
Study First Received: November 28, 2011
Last Updated: January 20, 2014
Health Authority: Switzerland: Independent Local Research Ethic Commission (Ethikkommission)

Keywords provided by University Hospital Inselspital, Berne:
catheter-directed thrombolysis
ilio-femoral deep vein thrombosis
Postthrombotic syndrome
Phlebographic scores
Phlebography
Catheters

Additional relevant MeSH terms:
Postthrombotic Syndrome
Postphlebitic Syndrome
Thrombosis
Venous Thrombosis
Venous Thromboembolism
Embolism and Thrombosis
Vascular Diseases
Cardiovascular Diseases
Venous Insufficiency
Phlebitis
Peripheral Vascular Diseases
Thromboembolism

ClinicalTrials.gov processed this record on July 26, 2014