Suresh Vedantham, professor of radiology and surgery, and ATTRACT Trial Coordinator Patricia Nieters look at a venogram of a patient with a blood clot in the leg. Photo by Robert Boston.
They told Suresh Vedantham, MD, professor of radiology and surgery, that it couldn’t be done.
Vedantham was making plans to conduct a nationwide clinical trial comparing different treatments for deep vein thromboses, or DVT, which are dangerous blood clots in the legs’ major veins.
Prior attempts to compare DVT treatments had failed to meet recruitment goals, but Vedantham was eager to test a new approach for treating DVTs that had the potential to significantly reduce complications from the clots, including pain and loss of mobility.
Four years later, recruitment for the NIH-sponsored ATTRACT (Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis) Trial has crossed the halfway mark.
“I think we’ve passed the ‘can it be done?’ threshold,” Vedantham says. “The amount of data we’re going to gather should enable us to affect clinical practice quite significantly.”
Having an impact on clinical practice was the driving factor that pushed Vedantham to become the principal investigator on the $10 million ATTRACT Trial four years ago at the relatively young age of 40.
“I’m very interested in public health and really want what I do to have a positive effect on people’s lives,” he says.
Preventing permanent damage
Vedantham was born and raised in western Chicago, the son of a radiologist and an interior designer. He earned his MD at the University of Chicago’s Pritzker School of Medicine, was a medical resident at the University of California at Los Angeles, and came to Washington University in 1998.
During a fellowship at Stanford University, Vedantham became interested in DVT. The initial symptoms of DVT are pain and swelling in the affected leg. Risk factors associated with this condition include surgery or trauma to the leg, genetic factors, immobilization, hormonal therapies and cancer. DVTs are more common in older patients but also can occur in childhood and throughout life.
The most immediate danger is the clot breaking loose and moving to the lungs, a condition called pulmonary embolism that kills about 100,000 people annually in the United States.
Patients are currently given a blood thinner, which prevents clot migration and formation of new clots but does not break up the original clot. Complications from the continued presence of the clot, known as post-thrombotic syndrome, occur in 50 percent of DVT patients.
“PTS causes long-term chronic pain, swelling, venous ulcers and difficulty walking,” Vedantham says. “This often leads to disability, is very costly and difficult to treat, and significantly impairs quality of life. If we can find a way to safely remove the clot when it is first diagnosed, we can prevent permanent damage to the leg veins and thereby prevent PTS.”
Pinpointing the location
Physicians have tried using clot-busting drugs, injected into an arm vein, to remove DVT since the early 1970s but found that the drugs increased bleeding risk too much.
New advances may enable the risk of clot-busting drugs such as tPA (tissue plasminogen activator) to be reduced significantly. In ATTRACT, study patients, who are randomly selected to receive the clot-busting treatment, Vedantham and his colleagues first pinpoint the location of the clot using X-ray imaging with injection of iodine-containing dye. They then thread a catheter into the patient’s vein and guide it to the DVT. Technology mounted on the end of the catheter delivers tPA directly into the clot, spreads it within the clot and manually chews the clot to help begin the breakup process.
Plans call for 692 patients to be enrolled in the ATTRACT Trial at up to 60 clinical centers nationwide.
“This trial is the first large-scale test of these new techniques, and the potential to change clinical DVT practice is very exciting,” Vedantham says. “If the trial is positive, it will alter the paradigm to say we don’t just prevent the next clot, we’ve got to also remove the existing clot first.”
More recently, Vedantham became director of the administrative core for a new multidisciplinary translational research center in thrombosis and hemostasis at the School of Medicine.
Vedantham views his new position as an exciting opportunity to be “part of the glue” that brings young investigators from multiple disciplines together through the new center. It’s a role he is pleased to fill.
“I’m focused on clinical research, but the ability to collaborate with other professionals across the research spectrum only improves our collective impact and my own ability to come up with new and better ideas,” he says. “As a unified center, my colleagues and I will employ extensive cross-disciplinary interaction, which is so easy to establish here at Washington University, to do even better research on DVT and other blood disorders.”
J. Evan Sadler, MD, PhD, chief of the Division of Hematology is the principal investigator for the new center, which is funded by a $9 million grant from the National Institutes of Health. Sadler says Vedantham’s experiences as principal investigator of the ATTRACT Trial are already helping trainees learning to do clinical research at the center.
“I am delighted that Suresh somehow found the time to lead the administrative core,” Sadler says. “He is a superb clinical investigator who is amazingly energetic, organized and effective.”
A magical place to live
Vedantham remembers looking down on St. Louis and other smaller cities in the Midwest when he was growing up in Chicago, but he now calls St. Louis a “magical” place to live.
He is married to Tanya Vedantham, a pediatric occupational therapist at Cardinal Glennon Hospital. Asked about hobbies, Vedantham immediately identifies the couple’s 6-year-old son, Shrey, as “the apple of our eyes.”
“I used to be a big fan of live music, and there’s still probably no one in the world who knows more about U2 concerts than I do,” he says. “But now our focus is Shrey.
“He is an engaging little fellow, and we rarely if ever sit still.”