Florida Center for Gastroenterology

Chronic deep venous thrombosis (DVT) can result in a significant venous outflow obstruction, often prompting the development of extensive compensatory mechanisms to maintain adequate circulation. We report a case of recurrent DVT, presenting with left lower extremity pain and edema. Venography revealed complete occlusion of the left common femoral vein with extensive collateral venous circulation. Given the presence of well‐formed collaterals and clinical stability, the patient was treated conservatively with continued anticoagulation without additional invasive intervention. This case highlights the physiologic adaptation of collateral formation that can allow for conservative management in chronic DVT and contributes to a better understanding of management strategies for high‐risk patients with recurrent thrombotic events.

RationaleThere is no broadly accessible treatment for patients with refractory chronic cough, a disease characterized by chronic cough that persists despite treatment for other cough-related etiologies or has no identified underlying cause.ObjectivesSOOTHE (NCT04678206), a phase 2b, randomized, placebo-controlled trial, evaluated the efficacy and safety of P2X3 antagonist camlipixant in adults with refractory chronic cough (cough duration, ⩾1 yr; baseline awake cough frequency, ⩾25 coughs/h).MethodsAfter a single-blind, 16-day placebo run-in, patients were randomized (1:1:1:1) to receive camlipixant 12.5, 50, or 200 mg twice daily or placebo for 4 weeks. The primary endpoint was change from baseline to Day 28 in objective 24-hour cough frequency. Secondary endpoints included cough severity and cough-related quality of life.Measurements and Main ResultsOverall, 310 patients were randomized. A statistically significant reduction in placebo-adjusted 24-hour cough frequency was seen in the 50 mg (−34.4%; 95% confidence interval, −50.5 to −13.3; P = 0.0033) and 200 mg (−34.2%; 95% confidence interval, −50.7 to −12.2; P = 0.0047) camlipixant arms. All camlipixant arms showed a trend for greater improvement in cough severity visual analog scale and Leicester Cough Questionnaire scores over placebo. Camlipixant was well tolerated with no serious treatment-emergent adverse events reported. Taste alteration occurred in 4.8–6.5% of patients in camlipixant arms (vs. 0% with placebo); these were usually mild–moderate.ConclusionsCamlipixant treatment reduced cough frequency and improved patient-reported outcomes in patients with refractory chronic cough, with an acceptable safety profile.Clinical trial registered with www.clinicaltrials.gov (NCT04678206).