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:

* Confirmed diagnosis of COVID-19 by reverse transcription polymerase chain reaction (RT-PCR)
* New admission to eligible CUIMC ICUs within 5 days

  * Transfer from nonparticipating to participating ICU is eligible if otherwise meets eligibility criteria.
  * Patients transferred between participating ICUs will maintain initial treatment assignment.
  * Patients not on therapeutic anticoagulation and who were already admitted to participating ICU within 5 days of trial initiation are additionally eligible.

Exclusion Criteria:

* Weight under 50kg
* Contraindication to anticoagulation in the opinion of the treating clinician including

  * overt bleeding
  * platelet count \<50,000
  * Bleeding Academic Research Consortium (BARC) major bleeding in the past 30 days
  * Gastrointestinal (GI) bleeding within 3 months
  * history of intracranial hemorrhage
  * Ischemic stroke within the past 2 weeks
  * craniotomy/major neurosurgery within the past 30 days
  * cardiothoracic surgery within the past 30 days
  * intra-abdominal surgery within 30 days prior to enrollment
  * Head or spinal trauma in the last months
  * History of uncorrected cerebral aneurysm or arteriovenous malformation (AVM)
  * Intracranial malignancy
  * Presence of an epidural or spinal catheter
  * Recent major surgery within the last 14 days
  * Decrease in hemoglobin \>3 g/dL over the last 24 hours
  * Allergic reaction to anticoagulants (e.g. Heparin Induced Thrombocytopenia) as documented in the electronic health records. Extracorporeal membrane oxygenation (ECMO) support or other mechanical circulatory support.
* Severe chronic liver dysfunction (history of portosystemic hypertension (HTN), esophageal varices, or Child-Pugh class C or above or similar Model For End-Stage Liver Disease (MELD) scores), abnormality in liver function tests (aspartate aminotransferase (AST), alanine aminotransferase (ALT), bilirubin) 5 times greater than upper normal limit.
* A history of congenital bleeding diatheses or anatomical anomaly that predisposes to hemorrhage (e.g. hemophilia, hereditary hemorrhagic telangiectasia)
* Treating physician preference for therapeutic anticoagulation
* Enrollment in other concurrent trials related to anticoagulant or antiplatelet therapy
* Existing treatment with therapeutic anticoagulation during the previous 7 days of hospitalization prior to ICU admission (e.g. for venous thromboembolism (VTE), atrial fibrillation, mechanical valve, etc).
* Do-not-resuscitate (DNR) /do-not-intubate (DNI) or comfort measures only (CMO) orders prior to randomization.
B: Inclusion Criteria:

* first episode of symptomatic, objectively confirmed idiopathic proximal deep vein thrombosis and/or pulmonary embolism;
* initial treatment with unfractionated heparin or low-molecular-weight heparin (or effective alternative) followed by a vitamin K antagonist (target INR 2.0-3.0). All patients will receive 6 or 12 months of oral anticoagulant treatment. Patients initially treated with thrombolytic therapy who received warfarin therapy are eligible for inclusion.

Exclusion Criteria:

* permanent risk factors for venous thromboembolism: patients known to have antiphospholipid antibodies or lupus anticoagulant (based on local laboratory criteria) or to have homozygous factor V Leiden or homozygous prothrombin G21210A or heterozygous factor V Leiden plus heterozygous prothrombin G21210A or antithrombin III deficiency; patients with active malignancy
* temporary risk factors for venous thromboembolism
* any recurrence of venous thromboembolism or bleeding episode during the established 6-month period of oral anticoagulant treatment
* allergy or intolerance of aspirin
* clear indication for aspirin or other anti-platelet therapy (e.g. clopidogrel, ticlopidine)
* clear indication for long-term anticoagulant therapy (e.g. recurrent idiopathic venous thromboembolism, prosthetic heart valve)
* treatment with non-selective COX-1/2 non-steroidal anti-inflammatory drugs
* life expectancy less than 6 months
* active bleeding or at high risk of bleeding (gastrointestinal bleeding within the past 12 months; endoscopic diagnosis of peptic ulcer disease or ulcerative esophagitis within the past 6 months unless there is documented endoscopic evidence of healing; intracranial bleeding within the past year; known bleeding diathesis)
* anticipated non-adherence to study medications
* inability to attend follow up because of geographic inaccessibility
* failure to provide informed consent
C: 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
D: Inclusion Criteria:

* Patients diagnosed as gastric cancer
* Elective and curative under general anesthesia
* ECOG score 0-2
* ASA score 3 or less than 3
* Informed consents

Exclusion Criteria:

* 2nd primary cancer
* VTE history within one year
* Anticoagulation history
* Allergic to heparin
* Pregnancy or expected pregnancy

Answer: C