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Landmark trials in thrombotic vascular disease: a critical appraisal of potential practice-changing trials in 2016–2017

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Abstract

Recent years have witnessed an onslaught of large, multicenter, randomized controlled trials evaluating the prevention and management of thrombotic vascular diseases. While these trials have applied rigorous methodology to pragmatic and clinically relevant questions, several important gaps in knowledge remain. In this review, we critically appraise landmark studies in thrombosis published between 2016 and 2017 that address several ongoing areas of clinical uncertainty. Specifically, we review the role of endovascular therapy in the prevention of post-thrombotic syndrome following acute lower limb deep vein thrombosis (DVT) (ATTRACT trial), the efficacy of edoxaban as the first direct oral anticoagulant used for the treatment of cancer-associated thrombosis (HOKUSAI VTE-Cancer study), whether aspirin can be considered for thromboprophylaxis post-major orthopedic surgery (EPCAT-2 trial), and the need for anticoagulant therapy for treatment of isolated distal DVT (CACTUS trial). Using illustrative cases, we highlight the applicability of these trials to current practice and emphasize the unanswered questions that remain.

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Authors and Affiliations

  1. Department of Medicine, St. Joseph’s Healthcare Hamilton, McMaster University, 50 Charlton Ave East, Hamilton, L8N 4A6, Canada

    Andrea Cervi

  2. Department of Medicine, St. Joseph’s Healthcare Hamilton, McMaster University, Room F-544, 50 Charlton Ave East, Hamilton, L8N 4A6, Canada

    James Demetrios Douketis

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  1. Andrea Cervi
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Correspondence to James Demetrios Douketis.

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Dr. Douketis is a consultant and advisory board participant for Janssen Pharmaceuticals, Bayer, Bristol Meyers Squibb, Sanofi, and Servier.

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Cervi, A., Douketis, J.D. Landmark trials in thrombotic vascular disease: a critical appraisal of potential practice-changing trials in 2016–2017. Intern Emerg Med 14, 355–363 (2019). https://doi.org/10.1007/s11739-018-1910-2

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