Patients with proximal deep-vein thrombosis (DVT) often develop post-thrombotic syndrome (PTS; chronic leg pain, swelling, redness, and ulcers) despite anticoagulant therapy. Investigators in the ATTRACT trial hypothesized that rapid removal of the thrombus by pharmacomechanical catheter-directed thrombolysis would reduce the risk of PTS. A total of 692 patients with acute proximal DVT were randomly assigned to anticoagulation plus pharmacomechanical thrombolysis or anticoagulation only. No significant difference was observed in the rate of PTS between 6 and 24 months (47% versus 48%; risk ratio 0.96, 95% CI 0.82–1.11, P = 0.56) or in recurrent venous thromboembolism during the 24-month follow-up (12% versus 8%; P = 0.09), but pharmacomechanical thrombolysis was associated with an increased rate of major bleeding events within 10 days (1.7% versus 0.3%; P = 0.049).