DEFIANCE: RCT af ClotTriever-systemet versus antikoagulering ved dyb venetrombose (DEFIANCE)
DEFIANCE - ClotTriever® Trombectomy System vs. Antikoagulation alene til behandling af dyb venetrombose
This study is a prospective, multicenter, randomized controlled trial of an interventional strategy using the ClotTriever System to achieve and maintain vessel patency (ClotTriever Intervention Arm) versus conservative medical management using anticoagulation therapy alone (Conservative Medical Management Arm) in the treatment of subjects with symptomatic unilateral iliofemoral DVT. The study will collect data on demographics, comorbidities, details from the DVT diagnosis and treatment, and clinical outcomes through the 6-month follow up visit.
Studieoversigt
Status
Status
Betingelser
Betingelser
Intervention / Behandling
Intervention / Behandling
Detaljeret beskrivelse
The study will compare the clinical outcomes of patients treated with an interventional strategy using the ClotTriever System to achieve and maintain vessel patency (ClotTriever Intervention Arm) versus conservative medical management using anticoagulation therapy alone (Conservative Medical Management Arm) in the treatment of symptomatic unilateral iliofemoral DVT. Approximately 300 subjects will be enrolled and randomized. All subjects who sign informed consent and who meet all of the inclusion criteria and none of the exclusion criteria will be randomized (1:1, ClotTriever Intervention Arm or Conservative Medical Management Arm).
Undersøgelsestype
Undersøgelsestype
Tilmelding (Anslået)
Tilmelding
Fase
Fase
- Ikke anvendelig
Kontakter og lokationer
Studiekontakt
Studiekontakt
- Navn: Sara Willis
- E-mail: sara.willis@stryker.com
Undersøgelse Kontakt Backup
- Navn: Mark Sung
- Telefonnummer: 949-466-9458
- E-mail: mark.sung@stryker.com
Studiesteder
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London, Det Forenede Kongerige
- Rekruttering
- Imperial College
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Kontakt:
- Alun H Davies, Prof.
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London, Det Forenede Kongerige
- Rekruttering
- GSST London/St Thomas
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Kontakt:
- Taha Khan, Mr
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Newcastle upon Tyne, Det Forenede Kongerige
- Rekruttering
- Freeman Hospital Newcastle upon Tyne
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Kontakt:
- Sandip Nandhra, Dr.
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Oxford, Det Forenede Kongerige
- Rekruttering
- Oxford - John Radcliffe
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Kontakt:
- Andrew Wigham, Dr
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Helsinki, Finland
- Rekruttering
- Helsinki University Hospital
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Kontakt:
- Matti Laine, MD, PhD
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Arizona
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Scottsdale, Arizona, Forenede Stater, 85258
- Rekruttering
- Honor Health
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Kontakt:
- Venkataramanan Gangadharan, MD
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Tucson, Arizona, Forenede Stater, 85704
- Rekruttering
- Pima Heart and Vascular
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Kontakt:
- Joseph Sabat, MD
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California
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Orange, California, Forenede Stater, 92868
- Rekruttering
- UCI Medical Center
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Kontakt:
- Anthony H Chau, MD
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Orange, California, Forenede Stater, 92868
- Rekruttering
- Vascular and Interventional Specialists of Orange County
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Kontakt:
- Theodore Bryan, MD
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Pasadena, California, Forenede Stater, 91105
- Rekruttering
- Huntington Health
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Kontakt:
- Theodore Teruya, MD
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Colorado
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Denver, Colorado, Forenede Stater, 80045
- Rekruttering
- University Of Colorado
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Kontakt:
- Jonathan D Lindquist, MD
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Connecticut
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New Haven, Connecticut, Forenede Stater, 06520
- Rekruttering
- Yale University
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Kontakt:
- Hamid R Mojibian, MD
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District of Columbia
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Washington D.C., District of Columbia, Forenede Stater, 20010
- Rekruttering
- MedStar Health Research Institution
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Kontakt:
- Saher S Sabri, MD
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Florida
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Bradenton, Florida, Forenede Stater, 34208
- Afsluttet
- Manatee Memorial Hospital
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Jacksonville, Florida, Forenede Stater, 32207
- Rekruttering
- Baptist Health Research Institute
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Kontakt:
- Bharat Gummadi, MD
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Lakeland, Florida, Forenede Stater, 33805
- Afsluttet
- Lakeland Vascular Institute
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Largo, Florida, Forenede Stater, 33770
- Afsluttet
- HCA Florida Largo Hospital
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Sarasota, Florida, Forenede Stater, 34239
- Rekruttering
- Sarasota Memorial Hospital
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Kontakt:
- Juan C Camacho-Vasquez, MD
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Tampa, Florida, Forenede Stater, 33607
- Rekruttering
- BayCare Health System
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Kontakt:
- Nicholas Turman, MD
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Georgia
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Savannah, Georgia, Forenede Stater, 31404
- Afsluttet
- Memorial Health University Medical Center
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Indiana
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Munster, Indiana, Forenede Stater, 46321
- Afsluttet
- Community Healthcare System
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Kentucky
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Edgewood, Kentucky, Forenede Stater, 41017
- Afsluttet
- St. Elizabeth Edgewood
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Maryland
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Baltimore, Maryland, Forenede Stater, 21201
- Rekruttering
- University of Maryland
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Kontakt:
- Khanjan Nagarsheth, MD
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Michigan
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Bay City, Michigan, Forenede Stater, 48708
- Rekruttering
- McLaren Healthcare
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Kontakt:
- Nicolas Mouawad, MD
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Detroit, Michigan, Forenede Stater, 48202
- Rekruttering
- Henry Ford Health
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Kontakt:
- Scott Kaatz, MD
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Midland, Michigan, Forenede Stater, 48670
- Rekruttering
- MyMichigan Medical Center
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Kontakt:
- Contantinos Constantinou, MD
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Missouri
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Columbia, Missouri, Forenede Stater, 65212
- Rekruttering
- University of Missouri
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Kontakt:
- Ambarish Bhat, MD
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Kansas City, Missouri, Forenede Stater, 64131
- Afsluttet
- Saint Luke's Hospital of Kansas City
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St Louis, Missouri, Forenede Stater, 63104
- Rekruttering
- St. Louis University
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Kontakt:
- Keith Pereira, MD
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Nevada
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Las Vegas, Nevada, Forenede Stater, 89102
- Rekruttering
- University Medical Center of Southern Nevada
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Kontakt:
- Ryan Rimer, MD
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New Jersey
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Camden, New Jersey, Forenede Stater, 08103
- Rekruttering
- Cooper University Hospital
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Kontakt:
- Laurel Hastings, MD
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Teaneck, New Jersey, Forenede Stater, 07666
- Afsluttet
- Holy Name Medical Center
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New York
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Bay Shore, New York, Forenede Stater, 11706
- Rekruttering
- Northwell Health
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Kontakt:
- Jonathan A Schor, MD
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Brooklyn, New York, Forenede Stater, 11215
- Rekruttering
- NYP-Brooklyn Methodist
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Kontakt:
- Rajesh K Malik, MD
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Buffalo, New York, Forenede Stater, 14203
- Afsluttet
- SUNY, The University at Buffalo
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New York, New York, Forenede Stater, 10032
- Rekruttering
- Columbia University Irving Medical Center
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Kontakt:
- Edvard Skripochnik, MD
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New York, New York, Forenede Stater, 10016
- Rekruttering
- NYU Langone Medical Center
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Kontakt:
- Katherine Teter, MD
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North Carolina
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Asheville, North Carolina, Forenede Stater, 28801
- Afsluttet
- Mission Health
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Ohio
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Cincinnati, Ohio, Forenede Stater, 45211
- Afsluttet
- Mercy Health - The Heart Institute
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Cleveland, Ohio, Forenede Stater, 44195
- Rekruttering
- Cleveland Clinic
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Kontakt:
- Aravinda Nanjundappa, MD
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Oklahoma
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Tulsa, Oklahoma, Forenede Stater, 74136
- Rekruttering
- Saint Francis Hospital
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Kontakt:
- Tucker J Harrison, DO
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Pennsylvania
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Erie, Pennsylvania, Forenede Stater, 16544
- Rekruttering
- Allegheny St. Vincent Hospital
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Kontakt:
- Orestis Pappas, MD
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Philadelphia, Pennsylvania, Forenede Stater, 19107
- Rekruttering
- Thomas Jefferson University
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Kontakt:
- Robert W Ford, MD
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Pittsburgh, Pennsylvania, Forenede Stater, 15212
- Rekruttering
- Allegheny General Health Research Network
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Kontakt:
- Abdullah A Shaikh, MD
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Rhode Island
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Providence, Rhode Island, Forenede Stater, 02903
- Rekruttering
- Rhode Island Hospital
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Kontakt:
- John Lee, MD
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South Carolina
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Greenville, South Carolina, Forenede Stater, 29615
- Afsluttet
- Prisma Health Upstate
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Spartanburg, South Carolina, Forenede Stater, 29303
- Rekruttering
- Spartanburg Medical Center
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Kontakt:
- Brian J Brown, MD
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West Columbia, South Carolina, Forenede Stater, 29169
- Afsluttet
- Lexington Medical Center
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Tennessee
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Nashville, Tennessee, Forenede Stater, 37232
- Rekruttering
- Vanderbilt University Medical Center
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Kontakt:
- Mark D Iafrati, MD
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Texas
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Dallas, Texas, Forenede Stater, 75390
- Rekruttering
- Clements University Hospital (UTSW)
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Kontakt:
- Michael C Siah, MD
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Virginia
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Norfolk, Virginia, Forenede Stater, 23507
- Rekruttering
- Sentara Norfolk General Hospital
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Kontakt:
- David J Dexter, MD
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Washington
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Spokane, Washington, Forenede Stater, 99204
- Afsluttet
- Providence Sacred Heart Med Center
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Wisconsin
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Milwaukee, Wisconsin, Forenede Stater, 53215
- Afsluttet
- Aurora St. Luke's Medical Center
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Baden, Schweiz
- Rekruttering
- Kantonsspital Baden
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Kontakt:
- Michael Kostrzewa, Dr.
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Bern, Schweiz
- Rekruttering
- Inselspital, Universitätsspital Bern
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Kontakt:
- Marc Schindewolf, Dr. med.
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Lucerne, Schweiz
- Rekruttering
- Luzerner Kantonsspital
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Kontakt:
- Thorsten Grumann, Dr. med.
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Augsburg, Tyskland
- Rekruttering
- Universitätsklinikum Augsburg
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Kontakt:
- Christian Scheurig-Münkler, PD Dr.
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Heidelberg, Tyskland
- Rekruttering
- Universitätsklinikum Heidelberg
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Kontakt:
- Christian Erbel, Prof. Dr.
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Baden-Würtemberg
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Tübingen, Baden-Würtemberg, Tyskland, 72076
- Rekruttering
- Universitätsklinikum Tübingen
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Kontakt:
- Gerd Grözinger, Dr. med.
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Hesse
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Frankfurt am Main, Hesse, Tyskland, 60389
- Rekruttering
- MVZ CCB Frankfurt und Main-Taunus GbR
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Kontakt:
- Michael Piorkowski, Dr. med.
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North Rhine-Westphalia
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Arnsberg, North Rhine-Westphalia, Tyskland, 59759
- Rekruttering
- Klinikum Hochsauerland GmbH
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Kontakt:
- Michael Lichtenberg, MD
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Saxony
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Leipzig, Saxony, Tyskland, 04109
- Rekruttering
- Universität Leipzig
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Kontakt:
- Andrej Schmidt, Prof Dr med
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State of Berlin
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Berlin, State of Berlin, Tyskland, 10117
- Afsluttet
- Charité - Universitätsmedizin Berlin
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Vienna, Østrig
- Rekruttering
- Vienna General Hospital (AKH Wien)
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Kontakt:
- Oliver Schlager, Dr. med
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Deltagelseskriterier
Berettigelseskriterier
Berettigelseskriterier
Aldre berettiget til at studere
Tager imod sunde frivillige
Køn, der er berettiget til at studere
Beskrivelse
Inclusion Criteria
- Age ≥ 18 years
- Proximal lower extremity unilateral DVT involving at least the common femoral, external iliac, or common iliac veins, alone or in combination
- Symptom onset within 12 weeks of enrollment in the study
- Significant symptoms, as defined by a Villalta score > 9
- Willing and able to provide informed consent
Exclusion Criteria
- Bilateral iliofemoral DVT
- Prior venous stent in the target venous segment
- IVC aplasia/hypoplasia or other congenital anatomic anomalies of the IVC or iliac veins
- IVC filter in place at the time of enrollment
- Limb-threatening circulatory compromise (e.g., phlegmasia)
- Clot in transit including IVC thrombus presenting as extension of >2cm into the IVC from the CIV
- Symptomatic PE with right heart strain where the physician judges that a DVT intervention is inappropriate at this time.
- Inability to be a candidate for intervention due to medical or technical reasons based on physician judgement
- Severe allergy, hypersensitivity to, or thrombocytopenia from heparin
- Severe allergy to iodinated contrast agents that cannot be mitigated
- Hemoglobin < 8.0 g/dL, INR > 1.7 before warfarin was started, or platelets < 50,000/µl which cannot be corrected prior to enrollment
- Severe renal impairment (estimated GFR < 30 ml/min) in patients who are not yet on dialysis
- Inability to provide therapeutic anticoagulation per Investigator discretion
- Uncontrolled severe hypertension on repeated readings (systolic > 180mmHg or diastolic > 105mmHg)
- Recently (< 30 days) had DVT interventional procedure
- Subject is participating in another study that may interfere with this study
- Life expectancy < 6 months or chronic non-ambulatory status
- Known hypercoagulable states that, in the opinion of the Investigator, cannot be medically managed throughout the study period
- Subject has any condition for which, in the opinion of the Investigator, participation would not be in the best interest of the subject (e.g., contraindication to use of ClotTriever per local approved labeling, compromise the well-being or that could prevent, limit, or confound the protocol-specified assessments)
- Subject has previously completed or withdrawn from this study
- Patient unwilling or unable to conduct the follow up visits per protocol
Studieplan
Hvordan er undersøgelsen tilrettelagt?
Design detaljer
- Primært formål: Behandling
- Tildeling: Randomiseret
- Interventionel model: Parallel tildeling
- Maskning: Ingen (Åben etiket)
Antal våben
Våben og indgreb
Deltagergruppe / ArmDeltagergruppe / Arm |
Intervention / BehandlingIntervention / Behandling |
|---|---|
|
Aktiv komparator: Interventional
Interventional strategy using the ClotTriever System to achieve and maintain vessel patency (ClotTriever Intervention Arm). |
Mechanical thrombectomy |
|
Aktiv komparator: Conservative Medical Management
Conservative medical management using anticoagulation therapy alone (Conservative Medical Management Arm). |
Anticoagulants are a group of medications that decrease your blood's ability to clot. |
Hvad måler undersøgelsen?
Primære resultatmål
Primære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Composite clinical endpoint constructed as a win ratio, a hierarchy of the following:
Tidsramme: 180 Days (+-14 Days)
|
|
180 Days (+-14 Days)
|
Sekundære resultatmål
Sekundære resultatmål
Resultatmål |
Foranstaltningsbeskrivelse |
Tidsramme |
|---|---|---|
|
Composite clinical endpoint constructed as a win ratio, a hierarchy of the following:
Tidsramme: 10 Days (+- 3 Days)
|
|
10 Days (+- 3 Days)
|
|
Assessment of PTS Severity:
Tidsramme: 180 Days (+-14 Days)
|
a. Assessment of PTS severity, as defined by the Villalta scale |
180 Days (+-14 Days)
|
Samarbejdspartnere og efterforskere
Sponsor
Sponsor
Efterforskere
Efterforskere
- Ledende efterforsker: Steven Abramowitz, MD, MedStar Health Research Institution
- Ledende efterforsker: Stephen Black, MD, St Thomas' Hospital (UK)
- Ledende efterforsker: Xhorlina Marko, MD, Henry Ford Health
Publikationer og nyttige links
Generelle publikationer
- Abramowitz SD, Marko X, D'Souza D, Noor S, Pereira K, Silver MJ, Rosenberg SP, Markovitz CD, Tu T, Weinberg I, Black S. Rationale and design of the DEFIANCE study: A randomized controlled trial of mechanical thrombectomy versus anticoagulation alone for iliofemoral deep vein thrombosis. Am Heart J. 2025 Mar;281:92-102. doi: 10.1016/j.ahj.2024.10.016. Epub 2024 Nov 3.
- Flumignan RL, Nakano LC, Flumignan CD, Baptista-Silva JC. Angioplasty or stenting for deep venous thrombosis. Cochrane Database Syst Rev. 2025 Feb 19;2(2):CD011468. doi: 10.1002/14651858.CD011468.pub2.
Datoer for undersøgelser
Studer store datoer
Studiestart (Faktiske)
Studiestart
Primær færdiggørelse (Anslået)
Primær færdiggørelse
Studieafslutning (Anslået)
Studieafslutning
Datoer for studieregistrering
Først indsendt
Først indsendt
Først indsendt, der opfyldte QC-kriterier
Først indsendt, der opfyldte QC-kriterier
Først opslået (Faktiske)
Først opslået
Opdateringer af undersøgelsesjournaler
Sidste opdatering sendt (Faktiske)
Sidste opdatering sendt
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier
Sidst verificeret
Sidst verificeret
Mere information
Begreber relateret til denne undersøgelse
Nøgleord
Yderligere relevante MeSH-vilkår
- Karsygdomme
- Hjerte-kar-sygdomme
- Embolisme og trombose
- Venøs insufficiens
- Tromboemboli
- Trombose
- Venøs trombose
- Posttrombotisk syndrom
- Venøs tromboembolisme
- Svovlforbindelser
- Organiske kemikalier
- Heterocykliske forbindelser, 1-ring
- Heterocykliske forbindelser
- Heterocykliske forbindelser, 2-ring
- Heterocykliske forbindelser, smeltet ring
- Pyraner
- Morpholiner
- Oxaziner
- Thiophener
- Coumarins
- Benzopyrans
- 4-hydroxycoumariner
- Rivaroxaban
- Warfarin
- Apixaban
Andre undersøgelses-id-numre
Andre undersøgelses-id-numre
- 22-001
Plan for individuelle deltagerdata (IPD)
Planlægger du at dele individuelle deltagerdata (IPD)?
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