DEFIANCE: RCT of ClotTriever System Versus Anticoagulation In Deep Vein Thrombosis

NCT ID: NCT05701917

Last Updated: 2026-01-06

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

300 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-01-06

Study Completion Date

2027-01-15

Brief Summary

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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.

Detailed Description

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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).

Conditions

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Venous Thromboembolism Deep Venous Thrombosis Post-Thrombotic Syndrome

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Interventional

Interventional strategy using the ClotTriever System to achieve and maintain vessel patency (ClotTriever Intervention Arm).

Group Type ACTIVE_COMPARATOR

ClotTriever System

Intervention Type DEVICE

Mechanical thrombectomy

Conservative Medical Management

Conservative medical management using anticoagulation therapy alone (Conservative Medical Management Arm).

Group Type ACTIVE_COMPARATOR

Commercially available/market approved anticoagulation medication including but not limited to: Heparin Sodium, Coumadin, Rivaroxaban, Apixaban, etc.

Intervention Type DRUG

Anticoagulants are a group of medications that decrease your blood's ability to clot.

Interventions

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ClotTriever System

Mechanical thrombectomy

Intervention Type DEVICE

Commercially available/market approved anticoagulation medication including but not limited to: Heparin Sodium, Coumadin, Rivaroxaban, Apixaban, etc.

Anticoagulants are a group of medications that decrease your blood's ability to clot.

Intervention Type DRUG

Eligibility Criteria

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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
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Inari Medical

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Steven Abramowitz, MD

Role: PRINCIPAL_INVESTIGATOR

MedStar Health Research Institution

Xhorlina Marko, MD

Role: PRINCIPAL_INVESTIGATOR

Henry Ford Health

Stephen Black, MD

Role: PRINCIPAL_INVESTIGATOR

St Thomas' Hospital (UK)

Locations

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Honor Health

Scottsdale, Arizona, United States

Site Status RECRUITING

Pima Heart and Vascular

Tucson, Arizona, United States

Site Status RECRUITING

UCI Medical Center

Orange, California, United States

Site Status RECRUITING

Vascular and Interventional Specialists of Orange County

Orange, California, United States

Site Status RECRUITING

University Of Colorado

Denver, Colorado, United States

Site Status RECRUITING

Yale University

New Haven, Connecticut, United States

Site Status RECRUITING

MedStar Health Research Institution

Washington D.C., District of Columbia, United States

Site Status RECRUITING

Manatee Memorial Hospital

Bradenton, Florida, United States

Site Status TERMINATED

Baptist Health Research Institute

Jacksonville, Florida, United States

Site Status RECRUITING

Lakeland Vascular Institute

Lakeland, Florida, United States

Site Status TERMINATED

HCA Florida Largo Hospital

Largo, Florida, United States

Site Status RECRUITING

Sarasota Memorial Hospital

Sarasota, Florida, United States

Site Status RECRUITING

BayCare Health System

Tampa, Florida, United States

Site Status RECRUITING

Memorial Health University Medical Center

Savannah, Georgia, United States

Site Status TERMINATED

Community Healthcare System

Munster, Indiana, United States

Site Status TERMINATED

St. Elizabeth Edgewood

Edgewood, Kentucky, United States

Site Status RECRUITING

University of Maryland

Baltimore, Maryland, United States

Site Status RECRUITING

McLaren Healthcare

Bay City, Michigan, United States

Site Status RECRUITING

Henry Ford Health

Detroit, Michigan, United States

Site Status RECRUITING

MyMichigan Medical Center

Midland, Michigan, United States

Site Status RECRUITING

University of Missouri

Columbia, Missouri, United States

Site Status RECRUITING

Saint Luke's Hospital of Kansas City

Kansas City, Missouri, United States

Site Status TERMINATED

St. Louis University

St Louis, Missouri, United States

Site Status RECRUITING

University Medical Center of Southern Nevada

Las Vegas, Nevada, United States

Site Status RECRUITING

Cooper University Hospital

Camden, New Jersey, United States

Site Status RECRUITING

Holy Name Medical Center

Teaneck, New Jersey, United States

Site Status SUSPENDED

Northwell Health

Bay Shore, New York, United States

Site Status RECRUITING

NYP-Brooklyn Methodist

Brooklyn, New York, United States

Site Status RECRUITING

SUNY, The University at Buffalo

Buffalo, New York, United States

Site Status TERMINATED

NYU Langone Medical Center

New York, New York, United States

Site Status RECRUITING

Columbia University Irving Medical Center

New York, New York, United States

Site Status RECRUITING

Mission Health

Asheville, North Carolina, United States

Site Status TERMINATED

Mercy Health - The Heart Institute

Cincinnati, Ohio, United States

Site Status TERMINATED

Cleveland Clinic

Cleveland, Ohio, United States

Site Status RECRUITING

Saint Francis Hospital

Tulsa, Oklahoma, United States

Site Status RECRUITING

Allegheny St. Vincent Hospital

Erie, Pennsylvania, United States

Site Status RECRUITING

Thomas Jefferson University

Philadelphia, Pennsylvania, United States

Site Status RECRUITING

Allegheny General Health Research Network

Pittsburgh, Pennsylvania, United States

Site Status RECRUITING

Rhode Island Hospital

Providence, Rhode Island, United States

Site Status RECRUITING

Prisma Health Upstate

Greenville, South Carolina, United States

Site Status TERMINATED

Spartanburg Medical Center

Spartanburg, South Carolina, United States

Site Status RECRUITING

Lexington Medical Center

West Columbia, South Carolina, United States

Site Status TERMINATED

Vanderbilt University Medical Center

Nashville, Tennessee, United States

Site Status RECRUITING

Clements University Hospital (UTSW)

Dallas, Texas, United States

Site Status RECRUITING

Sentara Norfolk General Hospital

Norfolk, Virginia, United States

Site Status RECRUITING

Providence Sacred Heart Med Center

Spokane, Washington, United States

Site Status RECRUITING

Aurora St. Luke's Medical Center

Milwaukee, Wisconsin, United States

Site Status TERMINATED

Vienna General Hospital (AKH Wien)

Vienna, , Austria

Site Status RECRUITING

Helsinki University Hospital

Helsinki, , Finland

Site Status RECRUITING

Universitätsklinikum Tübingen

Tübingen, Baden-Würtemberg, Germany

Site Status RECRUITING

MVZ CCB Frankfurt und Main-Taunus GbR

Frankfurt am Main, Hesse, Germany

Site Status RECRUITING

Klinikum Hochsauerland GmbH

Arnsberg, North Rhine-Westphalia, Germany

Site Status RECRUITING

Universität Leipzig

Leipzig, Saxony, Germany

Site Status RECRUITING

Charité - Universitätsmedizin Berlin

Berlin, State of Berlin, Germany

Site Status TERMINATED

Universitätsklinikum Augsburg

Augsburg, , Germany

Site Status RECRUITING

Universitätsklinikum Heidelberg

Heidelberg, , Germany

Site Status RECRUITING

Kantonsspital Baden

Baden, , Switzerland

Site Status RECRUITING

Inselspital, Universitätsspital Bern

Bern, , Switzerland

Site Status RECRUITING

Luzerner Kantonsspital

Lucerne, , Switzerland

Site Status RECRUITING

GSST London/St Thomas

London, , United Kingdom

Site Status RECRUITING

Imperial College

London, , United Kingdom

Site Status RECRUITING

Freeman Hospital Newcastle upon Tyne

Newcastle upon Tyne, , United Kingdom

Site Status RECRUITING

Oxford - John Radcliffe

Oxford, , United Kingdom

Site Status RECRUITING

Countries

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United States Austria Finland Germany Switzerland United Kingdom

Central Contacts

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Kevin Wilhelmi

Role: CONTACT

612-423-4410

Sara Willis

Role: CONTACT

Facility Contacts

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Venkataramanan Gangadharan, MD

Role: primary

Joseph Sabat, MD

Role: primary

Anthony H Chau, MD

Role: primary

Theodore Bryan, MD

Role: primary

Jonathan D Lindquist, MD

Role: primary

Hamid R Mojibian, MD

Role: primary

Saher S Sabri, MD

Role: primary

Bharat Gummadi, MD

Role: primary

Jesse Klein, DO

Role: primary

Juan C Camacho-Vasquez, MD

Role: primary

Nicholas Turman, MD

Role: primary

Alexander H Hou, MD

Role: primary

Khanjan Nagarsheth, MD

Role: primary

Nicolas Mouawad, MD

Role: primary

Scott Kaatz, MD

Role: primary

Contantinos Constantinou, MD

Role: primary

Ambarish Bhat, MD

Role: primary

Keith Pereira, MD

Role: primary

Ryan Rimer, MD

Role: primary

Laurel Hastings, MD

Role: primary

Jonathan A Schor, MD

Role: primary

Rajesh K Malik, MD

Role: primary

Katherine Teter, MD

Role: primary

Edvard Skripochnik, MD

Role: primary

Aravinda Nanjundappa, MD

Role: primary

Tucker J Harrison, DO

Role: primary

Orestis Pappas, MD

Role: primary

Robert W Ford, MD

Role: primary

Abdullah A Shaikh, MD

Role: primary

John Lee, MD

Role: primary

Brian J Brown, MD

Role: primary

Mark D Iafrati, MD

Role: primary

Michael C Siah, MD

Role: primary

David J Dexter, MD

Role: primary

Douglas A Murrey Jr., MD

Role: primary

Oliver Schlager, Dr. med

Role: primary

Matti Laine, MD, PhD

Role: primary

Gerd Grözinger, Dr. med.

Role: primary

Michael Piorkowski, Dr. med.

Role: primary

Michael Lichtenberg, MD

Role: primary

Andrej Schmidt, Prof Dr med

Role: primary

Christian Scheurig-Münkler, PD Dr.

Role: primary

Christian Erbel, Prof. Dr.

Role: primary

Michael Kostrzewa, Dr.

Role: primary

Marc Schindewolf, Dr. med.

Role: primary

Thorsten Grumann, Dr. med.

Role: primary

Taha Khan, Mr

Role: primary

Alun H Davies, Prof.

Role: primary

Sandip Nandhra, Dr.

Role: primary

Andrew Wigham, Dr

Role: primary

References

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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.

Reference Type RESULT
PMID: 39491572 (View on PubMed)

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.

Reference Type DERIVED
PMID: 39968829 (View on PubMed)

Other Identifiers

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22-001

Identifier Type: -

Identifier Source: org_study_id

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