Cancer-associated venous thromboembolism in the direct oral anticoagulants era: Insight from the COMMAND VTE Registry-2

被引：9

作者：

Chatani, Ryuki ^{[1
]}

Yamashita, Yugo ^{[2
]}

Morimoto, Takeshi ^{[3
]}

Mushiake, Kazunori ^{[1
]}

Kadota, Kazushige ^{[1
]}

Kaneda, Kazuhisa ^{[2
]}

Nishimoto, Yuji ^{[4
]}

Ikeda, Nobutaka ^{[5
]}

Kobayashi, Yohei ^{[6
]}

Ikeda, Satoshi ^{[7
]}

Kim, Kitae ^{[8
]}

Inoko, Moriaki ^{[9
]}

Takase, Toru ^{[10
]}

Tsuji, Shuhei ^{[11
]}

Oi, Maki ^{[12
]}

Takada, Takuma ^{[13
]}

Otsui, Kazunori ^{[14
]}

Sakamoto, Jiro ^{[15
]}

Ogihara, Yoshito ^{[16
]}

Inoue, Takeshi ^{[17
]}

Usami, Shunsuke ^{[18
]}

Chen, Po-Min ^{[19
]}

Togi, Kiyonori ^{[20
]}

Koitabashi, Norimichi ^{[21
]}

Hiramori, Seiichi ^{[22
]}

Doi, Kosuke ^{[23
]}

Mabuchi, Hiroshi ^{[24
]}

Tsuyuki, Yoshiaki ^{[25
]}

Murata, Koichiro ^{[26
]}

Takabayashi, Kensuke ^{[27
]}

Nakai, Hisato ^{[28
]}

Sueta, Daisuke ^{[29
]}

Shioyama, Wataru ^{[30
]}

Dohke, Tomohiro ^{[31
]}

Nishikawa, Ryusuke ^{[2
]}

Kimura, Takeshi ^{[27
]}

机构：

[1] Kurashiki Cent Hosp, Dept Cardiovasc Med, Kurashiki, Okayama, Japan

[2] Kyoto Univ, Grad Sch Med, Dept Cardiovasc Med, Kyoto, Japan

[3] Hyogo Coll Med, Dept Clin Epidemiol, Nishinomiya, Hyogo, Japan

[4] Hyogo Prefectural Amagasaki Gen Med Ctr, Dept Cardiol, Amagasaki, Hyogo, Japan

[5] Toho Univ, Ohashi Med Ctr, Div Cardiovasc Med, Tokyo, Japan

[6] Osaka Red Cross Hosp, Dept Cardiovasc Ctr, Osaka, Japan

[7] Nagasaki Univ, Grad Sch Biomed Sci, Dept Cardiovasc Med, Nagasaki, Japan

[8] Kobe City Med Ctr Gen Hosp, Dept Cardiovasc Med, Kobe, Hyogo, Japan

[9] Kitano Hosp, Tazuke Kofukai Med Res Inst, Cardiovasc Ctr, Osaka, Japan

[10] Kinki Univ Hosp, Dept Cardiol, Osaka, Japan

[11] Japanese Red Cross Wakayama Med Ctr, Dept Cardiol, Wakayama, Japan

[12] Japanese Red Cross Otsu Hosp, Dept Cardiol, Otsu, Shiga, Japan

[13] Tokyo Womens Med Univ, Dept Cardiol, Tokyo, Japan

[14] Kobe Univ Hosp, Dept Gen Internal Med, Kobe, Hyogo, Japan

[15] Tenri Hosp, Dept Cardiol, Tenri, Nara, Japan

[16] Mie Univ, Grad Sch Med, Dept Cardiol & Nephrol, Tsu, Mie, Japan

[17] Shiga Gen Hosp, Dept Cardiol, Moriyama, Shiga, Japan

[18] Kansai Elect Power Hosp, Dept Cardiol, Osaka, Japan

[19] Osaka Saiseikai Noe Hosp, Dept Cardiol, Osaka, Japan

[20] Kinki Univ, Fac Med, Div Cardiol, Nara Hosp, Ikoma, Japan

[21] Gunma Univ, Grad Sch Med, Dept Cardiovasc Med, Maebashi, Gumma, Japan

[22] Kokura Mem Hosp, Dept Cardiol, Kokura, Japan

[23] Natl Hosp Org Kyoto Med Ctr, Dept Cardiol, Kyoto, Japan

[24] Koto Mem Hosp, Dept Cardiol, Higashiomi, Japan

[25] Shimada Gen Med Ctr, Div Cardiol, Shimada, Japan

[26] Shizuoka City Shizuoka Hosp, Dept Cardiol, Shizuoka, Japan

[27] Hirakata Kohsai Hosp, Dept Cardiol, Hirakata, Osaka, Japan

[28] Sugita Genpaku Mem Obama Municipal Hosp, Dept Cardiovasc Med, Obama, Fukui, Japan

[29] Kumamoto Univ, Grad Sch Med Sci, Dept Cardiovasc Med, Kumamoto, Japan

[30] Shiga Univ Med Sci, Dept Cardiovasc Med, Otsu, Shiga, Japan

[31] Kohka Publ Hosp, Div Cardiol, Koka, Japan

来源：

THROMBOSIS RESEARCH | 2024年 / 234卷

关键词：

Cardio-oncology; Cancer-associated thrombosis; Venous thromboembolism; Anticoagulant; Recurrence; Bleeding; Mortality; REAL-WORLD; DEFINITION; GUIDELINES; EDOXABAN; THERAPY; DISEASE;

D O I：

10.1016/j.thromres.2023.12.016

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: There is a paucity of data on real -world management strategies and clinical outcomes of cancerassociated venous thromboembolism (VTE) in the direct oral anticoagulants (DOACs) era. Objectives: To investigate the status of cancer -associated VTE in the DOAC era. Methods: This multicenter, retrospective cohort study among 31 centers in Japan between 2015 and 2020 enrolled 5197 consecutive patients with acute symptomatic VTE, who were divided into 1507 patients (29 %) with active cancer and 3690 patients (71 %) without. Results: The cumulative 3 -year rate of anticoagulation discontinuation was significantly higher in patients with active cancer than in those without (62.7 % vs. 59.1 %, P < 0.001). The cumulative 5 -year incidence of recurrent VTE was higher in patients with active cancer than in those without (10.1 % vs. 9.1 %, P = 0.01), however, after adjusting for the confounders and competing risk of mortality, the excess risk of the active cancer group relative to the no active cancer group was no longer significant (HR: 0.95, 95 % CI: 0.73-1.24). The cumulative 5 -year incidence of major bleeding was much higher in the active cancer group (20.4 % vs. 11.6 %, P < 0.001). Even after adjusting for the confounders and competing risk of mortality, the risk of the active cancer group relative to the no active cancer group remained significant (HR: 1.36, 95 % CI: 1.11-1.66). Conclusions: The current large real -world registry revealed that the risk of major bleeding was still higher in patients with active cancer than in those without, leading to the frequent anticoagulation discontinuation, which has been still a huge challenge to overcome in the DOAC era.

引用

页码：86 / 93

页数：8

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