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Acute Thrombosis of Deep Veins of Proximal Lower ExtremityPhase 3NL28394NCT00970619

DUTCH CAVA-trial: CAtheter Versus Anticoagulation Alone for Acute Primary (Ilio)Femoral DVT.

A Phase 3 study testing Ekos endowave system thrombolysis in people with Acute Thrombosis of Deep Veins of Proximal Lower Extremity, run by Maastricht University Medical Center at 16 sites in Netherlands.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Rationale: Iliofemoral deep venous thrombosis (IFDVT) is associated with significant post thrombotic morbidity. The presence of both obstruction and reflux significantly increases the chances for development of post-thrombotic syndrome (PTS). Read more about this study

Who is it for?
Ages 18 to 85 years
What is being tested?
Ekos endowave system thrombolysis
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
184 participants
Where
16 sitesNetherlands
Study dates
May 2010to Nov 2018
Phase
Phase 3
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 85 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Objectively documented IFDVT
  • Acute stage IFDVT, complaints less than 14 days
  • Life expectancy longer than 6 months
  • First thrombus in the affected limb

Who cannot join

  • History of GI bleeding within 1 year
  • History of cardiovascular accident /central nervous system disease within 1 year
  • Severe hypertension (>180/100 mmHg)
  • Active malignancy
  • Major surgery within 6 weeks
  • Previous thrombosis of the affected limb (secondary thrombosis)
Show all 11Show fewer
  • Varicosities/venous insufficiency Clinical, Etiologic, Anatomic, and Pathophysiologic (CEAP) classification C3 or higher
  • Pregnancy
  • Immobility (wheelchair dependent)
  • Alanine aminotransferase (ALAT) > 3 times normal range
  • estimated Glomerular Filtration Rate (eGFR) < 30 mL/min

Trial locations and contacts

16 sites in 1 country.

16 sites in 1 country

Netherlands16 sites
  • Academisch Medisch Centrum

    Amsterdam

  • VuMC

    Amsterdam

  • Nij Smellinghe

    Drachten

  • Catharina Ziekenhuis Eindhoven

    Eindhoven

  • MMC Eindhoven

    Eindhoven

  • St Anna Ziekenhuis

    Geldrop

  • Atrium MC Heerlen

    Heerlen

  • Elkerliek Ziekenhuis

    Helmond

  • Maastricht University Medical Centre

    Maastricht, Limburg, 6202 AZ

  • St Antonius

    Nieuwegein

  • Laurentius Roermond

    Roermond

  • Maasstad ziekenhuis

    Rotterdam

  • Haga Ziekenhuis

    The Hague

  • VieCuri

    Venlo

  • Sint Jans Gasthuis

    Weert

  • Isala klinieken

    Zwolle

Other trials in Netherlands

About this study

Official title: Ultrasound Accelerated Catheter-directed Thrombolysis for Primary Iliofemoral Deep Vein Thrombosis (IFDVT) Compared to Non-invasive Conventional Anticoagulant Therapy Alone: a Dutch Randomized Controlled Multicenter Clinical Trial

Rationale: Iliofemoral deep venous thrombosis (IFDVT) is associated with significant post thrombotic morbidity. The presence of both obstruction and reflux significantly increases the chances for development of post-thrombotic syndrome (PTS). Early thrombolysis may reduce the incidence of PTS as compared to treatment with conventional anticoagulant medication alone. Improvement of the health related quality of life (HRQOL) has been reported after surgical clot removal. The investigators hypothesize that such improvements could also be reached after catheter-directed thrombolysis (CDT).

Objective: To assess whether CDT for the treatment of IFDVT can safely and effectively reduce post-thrombotic morbidity after one year. The secondary objective is to study whether CDT intervention has a positive effect on the HRQOL of patients with IFDVT and to assess late PTS.

Read more

Study design: Prospective, multicenter, single-blind, allocation concealed, randomized controlled trial Study population: All consecutive patients with IFDVT presenting at the emergency or outpatient departments of the participating centers. The thrombus should not be older than 14 days at randomization.

Intervention: After randomization patients will be allocated to either conservative anticoagulant treatment or to CDT combined with conservative anticoagulant treatment.

Main study parameters/endpoints: The primary efficacy outcome is the proportion of PTS at one year; a decline in PTS incidence from 25% to 8% is anticipated. The secondary outcome is the Health related Quality of life. The principal safety outcome is major bleeding during anticoagulant therapy. Bleeding as well as events of recurrent thrombosis will be monitored. Measurements of markers of coagulation and inflammation will be performed during follow-up. After CDT the patency of the venous system in the affected lower limb will be assessed as well as the percentage of clot lysis. The development of late PTS during follow-up will also be monitored.

Nature and extent of the burden and risks associated with participation, benefit and group relatedness: For patients who are randomized to CDT a hospital stay for 24-96 hours is mandatory. All patients will undergo additional imaging by magnetic resonance venography and air phletysmography (if available) at baseline and after 12 months; blood will be taken at these visits. Clinical follow-up visits will be matching usual care at 3, 6, 12 months. Health-related quality of life (HRQOL) questionnaires will be filled out by all patients at baseline, 3, 6 and 12 months after the event; and once a year during the entire study duration. Further treatment will be in accordance with current guidelines for antithrombotic treatment. There may be an enhanced risk of bleeding in the thrombolysis group. The expected benefit is reduction of PTS from 25% to 8%, together with an improved quality of life.

Being tested
Ekos endowave system thrombolysis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Ekos endowave system thrombolysisDevice

    Also called Ekos endowave ® system

    Catheter directed thrombolysis will be performed with an Ekos Endowave ® system (EKOS Corporation, Bothell, WA). The system uses a standard guide wire to position the Intelligent Drug Delivery Catheter across the length of the target clot. The guide wire is introduced through the popliteal vein. Along the guide wire the catheter is positioned. The location of the dispersion catheter is controlled and if necessary adjusted by X-ray. The guide wire is then pulled out and replaced with the Microsonic core (a miniscule high frequency (2MHz) ultrasound transducer). The system automatically monitors and controls the microsonic energy delivery. This system does not fragment the thrombus but only gives a structural change by which a better penetration of the thrombolytic agent is achieved.

Study groups in NCT00970619
Study groupRoleWhat they receive
Conventional anticoagulation therapyNo interventionConservative treatment consists of an initial treatment with therapeutic doses of low molecular weight heparin (LMWH) in combination with vitamin K-antagonists, followed by treatment with vitamin K-antagonist alone (after completing LMWH treatment of at least 5-7 days and after an international normalized ratio (INR) above 2 has been reached on two consecutive measurements). Or alternatively the new direct activated factor X inhibitors can be used as anticoagulation therapy. Anticoagulant treatment will be installed according to national and international guidelines (ACCP 2008 [23], CBO 2008 [24]) tailored based on the character of the event (6 months of therapy for idiopathic DVT and 3 months for provoked DVT).
Ekos Endowave system thrombolysisExperimentalCatheter directed thrombolysis will be performed with an Ekos Endowave ® system (EKOS Corporation, Bothell, WA). The system uses a standard guide wire to position the Intelligent Drug Delivery Catheter across the length of the target clot. The guide wire is introduced through the popliteal vein. Along the guide wire the catheter is positioned. The location of the dispersion catheter is controlled and if necessary adjusted by X-ray. The guide wire is then pulled out and replaced with the Microsonic core (a miniscule high frequency (2MHz) ultrasound transducer). The system automatically monitors and controls the microsonic energy delivery. This system does not fragment the thrombus but only gives a structural change by which a better penetration of the thrombolytic agent is achieved.
Receives: Device: Ekos endowave system thrombolysis

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Post thrombotic syndrome (percentage of patients with PTS) one year following the acute thrombotic event.

    Measured: one year

Secondary outcomes (5)
  1. The Health Related Quality of Life (HRQOL)

    Measured: 5 years

  2. PTS during follow-up

    Measured: 5 years

  3. Recurrent venous thrombo-embolisms (VTE): DVT/Pulmonary Embolism during follow-up

    Measured: 5 years

  4. Clot lysis, patency and valve function

    Measured: 5 years

  5. Measurements of markers of coagulation and inflammation

    Measured: 5 years

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted2 Sep 2009 (estimated)
  2. Study startMay 2010
  3. Primary completionNov 2018
  4. Study completionNov 2018

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
184 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT00970619
Sponsor's protocol ID
MEC 09-2-093
Acronym
NL28394
Status last verified
Mar 2020
First submitted
1 Sep 2009
Last updated
6 Mar 2020
Results posted
No
Data monitoring committee
Yes

Publications

  • 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.

    PubMed 39968829
  • Iding AFJ, Alkarithi G, Cate HT, Ariens RAS, Ten Cate-Hoek AJ. Fibrinogen levels and clot properties identify patients who benefit from catheter-directed thrombolysis after DVT. Blood Adv. 2024 Jun 11;8(11):2924-2932. doi: 10.1182/bloodadvances.2023012493.

    PubMed 38547453
  • Arnoldussen CWKP, Notten P, Brans R, Vroegindeweij D, Tick LW, van de Poel MHW, Wikkeling ORM, Vleming LJ, Koster A, Jie KG, Jacobs EMG, Planken N, Wittens CHA, Ten Cate H, Wildberger JE, Ten Cate-Hoek AJ. Clinical impact of assessing thrombus age using magnetic resonance venography prior to catheter-directed thrombolysis. Eur Radiol. 2022 Jul;32(7):4555-4564. doi: 10.1007/s00330-022-08599-5. Epub 2022 Mar 28.

    PubMed 35347362
  • Notten P, de Smet AAEA, Tick LW, van de Poel MHW, Wikkeling ORM, Vleming LJ, Koster A, Jie KG, Jacobs EMG, Ebben HP, Coppens M, Ten Cate H, Wittens CHA, Ten Cate-Hoek AJ. CAVA (Ultrasound-Accelerated Catheter-Directed Thrombolysis on Preventing Post-Thrombotic Syndrome) Trial: Long-Term Follow-Up Results. J Am Heart Assoc. 2021 Jun;10(11):e018973. doi: 10.1161/JAHA.120.018973. Epub 2021 May 25.

    PubMed 34032127
  • Notten P, Arnoldussen CWKP, Brans R, de Smet AAEA, Tick LW, van de Poel MHW, Wikkeling ORM, Vleming LJ, Koster A, Jie KG, Jacobs EMG, Ebben HP, Planken N, Ten Cate H, Wittens CHA, Ten Cate-Hoek AJ. Association of Successful Ultrasound-Accelerated Catheter-Directed Thrombolysis with Postthrombotic Syndrome: A Post Hoc Analysis of the CAVA Trial. Thromb Haemost. 2020 Aug;120(8):1188-1199. doi: 10.1055/s-0040-1713171. Epub 2020 Jun 30.

    PubMed 32604427
  • Notten P, Ten Cate-Hoek AJ, Arnoldussen CWKP, Strijkers RHW, de Smet AAEA, Tick LW, van de Poel MHW, Wikkeling ORM, Vleming LJ, Koster A, Jie KG, Jacobs EMG, Ebben HP, Coppens M, Toonder I, Ten Cate H, Wittens CHA. Ultrasound-accelerated catheter-directed thrombolysis versus anticoagulation for the prevention of post-thrombotic syndrome (CAVA): a single-blind, multicentre, randomised trial. Lancet Haematol. 2020 Jan;7(1):e40-e49. doi: 10.1016/S2352-3026(19)30209-1. Epub 2019 Nov 27.

    PubMed 31786086

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Ekos endowave system thrombolysis in people with Acute Thrombosis of Deep Veins of Proximal Lower Extremity, run by Maastricht University Medical Center at 16 sites in Netherlands.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 6 Mar 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 16 sites in Netherlands. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Post thrombotic syndrome (percentage of patients with PTS) one year following the acute thrombotic event. (time frame: one year). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT00970619, which also lists 6 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 6 Mar 2020.

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