BackTable Vascular & Interventional Ep. 594 How New Guidelines are Shaping Acute DVT Management with Dr. Steven Abramowitz
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Dec 2, 2025 Dr. Steven Abramowitz, a vascular surgeon and physician executive director at MedStar, discusses the latest guidelines on deep venous thrombosis (DVT) management. He delves into the implications of the ATTRACT trial and the CLOUT registry, emphasizing how mechanical thrombectomy is evolving. Abramowitz highlights key techniques like IVUS for treatment endpoint determination and the importance of collaboration with referring physicians. He also touches on the role of anticoagulation and the need for redefining DVT to improve patient outcomes.
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Better Anticoagulation Confounds Outcomes
- Increased DOAC use and better anticoagulation practices likely lowered re-thrombosis rates compared with older trials.
- It's unclear how much improved drugs vs. intervention drive better patency without further subset analyses.
Mechanical Tools Extend Treatment Window
- Mechanical tools can treat subacute thrombus beyond the 2-week lytic window, and 'chronic' in CLOUT meant >6 weeks but not necessarily post-thrombotic scar.
- Different devices target wall-adherent organized thrombus in older clots.
Be Judicious With Aggressive Devices
- Balance aggressive thrombus removal with the risk of endothelial or valve injury and avoid surgical laceration of veins.
- Use available data (animal and human) showing no clear valve-damage signal but stay judicious in technique.