Please select the eligibility criteria that correspond to the clinical trial below.
Title: The BERN Ultrasound-enhanced Thrombolysis for Ilio-Femoral Deep Vein Thrombosis versUs Standard Catheter Directed thromboLysis Trial (BERNUTIFUL-Trial)
Brief Summary: Patients with deep vein thrombosis (DVT) of the ilio-femoral veins have increased risk for developing post-thrombotic syndrome (PTS) and recurrent venous thromboembolism compared to more distal DVT. There's evidence that the early removal of the obstructing thrombus by catheter directed thrombolysis (CDT) reduces the risk of developing a PTS, and a higher degree of thrombolysis is associated with lower incidence of PTS, better quality of life and lower risk of recurrent venous thromboembolism. A further development is ultrasound-enhanced thrombolysis combining CDT with a sophisticated catheter system that employs high-frequency, low-dose ultrasound. In vitro experiments showed that adding ultrasound to thrombolytic drugs accelerates thrombolysis while Ultrasound exposure alone results in no thrombolysis, however the superiority of ultrasound-enhanced thrombolysis over standard CDT has never been formally assessed in vivo. The hypothesis for this study is that ultrasound-enhanced thrombolysis reaches a higher degree of thrombolysis than standard CDT in patients with symptomatic ilio-femoral DVT.


Options:
A: Inclusion Criteria:

* Adult patient (≥ 18 years of age)
* Positive COVID-test
* Under mechanical ventilation
* D-Dimers\>1.2 mg/L

Exclusion Criteria:

* Pregnancy
* Allergy to the drug (bivalirudin)
* Inherited coagulation abnormalities
* No informed consent
B: Inclusion Criteria:

* COVID-19 infection confirmed by SARS-Cov2 - RT PCR - as per protocol
* Able to start the treatment within 24 hours from time of diagnosis
* Patient with mild symptoms as defined by WHO, with PaO2 \> 93%
* Signed written consent of the patient
* Accepts and has the ability to be reached by phone during the study duration, plus a designated a contact person who can be contacted in case of emergency

Exclusion Criteria:

* Blood pressure \< 90/60mm Hg
* Respiratory rate ≥ 30/min
* Known cardiac condition
* Known G6PD deficiency
* Patients with \< 45kg
* eGFR \< 30 ml/min or ALT ≥ 3N or body temperature ≥ 38°C or any life-threatening comorbidity
* Any reason that makes it impossible to monitor the patient during the study period
* Baseline ECG prior to randomization showing QTc \> 500 ms
* Ongoing treatment other than symptomatic
* history of retinopathy
* Absolute contra-indication to treatment with hydroxychloroquine (known hypersensitivity, concomitant treatment at risk of torsades de pointes)
* Contraindication to any study medication including allergy
* Ongoing treatment with high dose systemic chronic corticosteroid (\> 40 mg)
* Patients treated by immunosuppressants treatment at the time of randomization
* Known Pregnant women and breastfeeding women
C: Inclusion Criteria: adult patient with COVID-19 infections, admitted to:

* an acute non-critical medical ward with admission D-dimer levels \>1,000ng/mL, or
* an acute critical ward (ICU, intermediate care unit)

Exclusion Criteria:

* ongoing or planned therapeutic anticoagulation for any other indication
* contra-indication to therapeutic anticoagulation
* hypersensitivity to heparin
* personal history of heparin-induced thrombocytopenia
* suspected or confirmed bacterial endocarditis
* bleeding events or tendency due to a suspected or confirmed hemostatic bleeding disorder
* organic lesion prone to bleeding
* platelet count \<50G/L, Hb level \<80g/L
* ongoing or recent (\<30 days) major bleeding, ischemic stroke, trauma, surgery
* use of dual antiplatelet therapy
* pregnancy
* bodyweight \<40kg or \>150kg.
* end of life care setting
* unwillingness to consent
* ongoing participation in a COVID-19 randomized clinical trial testing another therapeutic intervention
D: Inclusion Criteria:

* Symptomatic proximal DVT involving the iliac and/or common femoral vein, confirmed by Duplex Sonography, Angio-CT, Angio-MRI or Phlebography
* Written informed consent

Exclusion Criteria

* Age less than 18 years or greater than 75 years
* Symptom duration \> 14 days for the DVT episode in the index leg (i.e., non-acute DVT).
* In the index leg: established post-thrombotic syndrome (PTS) or previous symptomatic DVT within the last 2 years.
* Limb-threatening circulatory compromise.
* PE with hemodynamic compromise (i.e., hypotension).
* Inability to tolerate catheter procedure due to severe dyspnea or acute systemic illness.
* Allergy, hypersensitivity, or thrombocytopenia from heparin, r-tPA, or iodinated contrast, except for mild-moderate contrast allergies for which steroid pre-medication can be used.
* Known significant bleeding risk, or known coagulation disorder (including vitamin K antagonists with INR \> 2.0 and platelet count \< 100 000/mm3)
* Severe renal impairment (estimated GFR \< 30 ml/min).
* Active bleeding, recent (\< 3 mo) GI bleeding, severe liver dysfunction, bleeding diathesis.
* Recent (\< 3 mo) internal eye surgery or hemorrhagic retinopathy; recent (\< 10 days) major surgery, cataract surgery, trauma, CPR, obstetrical delivery, or other invasive procedure.
* History of stroke or intracranial/intraspinal bleed, tumor, vascular malformation, aneurysm.
* Severe hypertension on repeated readings (systolic \> 180 mmHg or diastolic \> 105 mmHg).
* Pregnant, lactation or parturition within the previous 30 days (positive pregnancy test, women of childbearing age must be tested or use a medically accepted method of birth control).
* Recently (\< 1 mo) had thrombolysis.
* Life expectancy \< 6 months or chronic non-ambulatory status.
* Participating in any other investigational drug or device study or previous enrollment in this study
* Inability to provide informed consent or to comply with study assessments (e.g. due to cognitive impairment or geographic distance).
* Any other condition that the investigator feels would place the patient at increased risk if the investigational therapy is initiated

Answer: D