Yugo Yamashita1, Takeshi Morimoto2, Hidewo Amano3, Toru Takase4, Seiichi Hiramori5, Kitae Kim6, Takashi Konishi7, Masaharu Akao8, Yohei Kobayashi9, Takeshi Inoue10, Maki Oi11, Toshiaki Izumi12, Kotaro Takahashi13, Tomohisa Tada13, Po-Min Chen14, Koichiro Murata15, Yoshiaki Tsuyuki16, Hiroshi Sakai17, Syunsuke Saga18, Tomoki Sasa19, Jiro Sakamoto20, Chinatsu Yamada21, Minako Kinoshita22, Kiyonori Togi23, Tomoyuki Ikeda24, Katsuhisa Ishii25, Kazuhisa Kaneda26, Hiroshi Mabuchi27, Hideo Otani28, Kensuke Takabayashi29, Mamoru Takahashi30, Hiroki Shiomi1, Takeru Makiyama1, Koh Ono1, Takeshi Kimura1. 1. Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University. 2. Department of Clinical Epidemiology, Hyogo College of Medicine. 3. Department of Cardiovascular Medicine, Kurashiki Central Hospital. 4. Department of Cardiology, Kindai University Hospital. 5. Department of Cardiology, Kokura Memorial Hospital. 6. Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital. 7. Department of Cardiology, Japanese Red Cross Otsu Hospital. 8. Department of Cardiology, National Hospital Organization Kyoto Medical Center. 9. Department of Cardiovascular Center, Osaka Red Cross Hospital. 10. Department of Cardiology, Shiga Medical Center for Adults. 11. Department of Cardiology, Japanese Red Cross Wakayama Medical Center. 12. Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital. 13. Department of Cardiology, Shizuoka General Hospital. 14. Department of Cardiology, Osaka Saiseikai Noe Hospital. 15. Department of Cardiology, Shizuoka City Shizuoka Hospital. 16. Division of Cardiology, Shimada Municipal Hospital. 17. Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science. 18. Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center. 19. Department of Cardiology, Kishiwada City Hospital. 20. Department of Cardiology, Tenri Hospital. 21. Department of Cardiovascular Medicine, Kyoto Okamoto Memorial Hospital. 22. Department of Cardiology, Nishikobe Medical Center. 23. Division of Cardiology, Nara Hospital, Kindai University Faculty of Medicine. 24. Department of Cardiology, Hikone Municipal Hospital. 25. Department of Cardiology, Kansai Electric Power Hospital. 26. Department of Cardiology, Mitsubishi Kyoto Hospital. 27. Department of Cardiology, Koto Memorial Hospital. 28. Department of Cardiovascular Medicine, Sugita Genpaku Memorial Obama Municipal Hospital. 29. Department of Cardiology, Hirakata Kohsai Hospital. 30. Department of Cardiology, Shimabara Hospital.
Abstract
BACKGROUND: Venous thromboembolism (VTE) has a long-term risk of recurrence, which can be prevented by anticoagulation therapy.Methods and Results: The COMMAND VTE Registry is a multicenter registry enrolling 3,027 consecutive patients with acute symptomatic VTE between January 2010 and August 2014. The entire cohort was divided into the transient risk (n=855, 28%), unprovoked (n=1,477, 49%), and cancer groups (n=695, 23%). The rate of anticoagulation discontinuation was highest in the cancer group (transient risk: 37.3% vs. unprovoked: 21.4% vs. cancer: 43.5% at 1 year, P<0.001). The cumulative 5-year incidences of recurrent VTE, major bleeding and all-cause death were highest in the cancer group (recurrent VTE: 7.9% vs. 9.3% vs. 17.7%, P<0.001; major bleeding: 9.0% vs. 9.4% vs. 26.6%, P<0.001; and all-cause death: 17.4% vs. 15.3% vs. 73.1%, P<0.001). After discontinuation of anticoagulation therapy, the cumulative 3-year incidence of recurrent VTE was lowest in the transient risk group (transient risk: 6.1% vs. unprovoked: 15.3% vs. cancer: 13.2%, P=0.001). The cumulative 3-year incidence of recurrent VTE beyond 1 year was lower in patients on anticoagulation than in patients off anticoagulation at 1 year in the unprovoked group (on: 3.7% vs. off: 12.2%, P<0.001), but not in the transient risk and cancer groups (respectively, 1.6% vs. 2.5%, P=0.30; 5.6% vs. 8.6%, P=0.44). CONCLUSIONS: The duration of anticoagulation therapy varied widely in discordance with current guideline recommendations. Optimal duration of anticoagulation therapy should be defined according to the risk of recurrent VTE and bleeding as well as death.
BACKGROUND:Venous thromboembolism (VTE) has a long-term risk of recurrence, which can be prevented by anticoagulation therapy.Methods and Results: The COMMAND VTE Registry is a multicenter registry enrolling 3,027 consecutive patients with acute symptomatic VTE between January 2010 and August 2014. The entire cohort was divided into the transient risk (n=855, 28%), unprovoked (n=1,477, 49%), and cancer groups (n=695, 23%). The rate of anticoagulation discontinuation was highest in the cancer group (transient risk: 37.3% vs. unprovoked: 21.4% vs. cancer: 43.5% at 1 year, P<0.001). The cumulative 5-year incidences of recurrent VTE, major bleeding and all-cause death were highest in the cancer group (recurrent VTE: 7.9% vs. 9.3% vs. 17.7%, P<0.001; major bleeding: 9.0% vs. 9.4% vs. 26.6%, P<0.001; and all-cause death: 17.4% vs. 15.3% vs. 73.1%, P<0.001). After discontinuation of anticoagulation therapy, the cumulative 3-year incidence of recurrent VTE was lowest in the transient risk group (transient risk: 6.1% vs. unprovoked: 15.3% vs. cancer: 13.2%, P=0.001). The cumulative 3-year incidence of recurrent VTE beyond 1 year was lower in patients on anticoagulation than in patients off anticoagulation at 1 year in the unprovoked group (on: 3.7% vs. off: 12.2%, P<0.001), but not in the transient risk and cancer groups (respectively, 1.6% vs. 2.5%, P=0.30; 5.6% vs. 8.6%, P=0.44). CONCLUSIONS: The duration of anticoagulation therapy varied widely in discordance with current guideline recommendations. Optimal duration of anticoagulation therapy should be defined according to the risk of recurrent VTE and bleeding as well as death.