Yuji Nishimoto1, Yugo Yamashita2, Takeshi Morimoto3, Syunsuke Saga1, Hidewo Amano4, Toru Takase5, Seiichi Hiramori6, Kitae Kim7, Maki Oi8, Masaharu Akao9, Yohei Kobayashi10, Mamoru Toyofuku11, Toshiaki Izumi12, Tomohisa Tada13, Po-Min Chen14, Koichiro Murata15, Yoshiaki Tsuyuki16, Tomoki Sasa17, Jiro Sakamoto18, Minako Kinoshita19, Kiyonori Togi20, Hiroshi Mabuchi21, Kensuke Takabayashi22, Hiroki Shiomi2, Takao Kato2, Takeru Makiyama2, Koh Ono2, Yukihito Sato1, Takeshi Kimura2. 1. Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center. 2. Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University. 3. Department of Clinical Epidemiology, Hyogo College of Medicine. 4. Department of Cardiovascular Medicine, Kurashiki Central Hospital. 5. Department of Cardiology, Kinki University Hospital. 6. Department of Cardiology, Kokura Memorial Hospital. 7. Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital. 8. Department of Cardiology, Japanese Red Cross Otsu Hospital. 9. Department of Cardiology, National Hospital Organization Kyoto Medical Center. 10. Department of Cardiovascular Center, Osaka Red Cross Hospital. 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 Cardiology, Kishiwada City Hospital. 18. Department of Cardiology, Tenri Hospital. 19. Department of Cardiology, Nishikobe Medical Center. 20. Division of Cardiology, Nara Hospital, Kinki University Faculty of Medicine. 21. Department of Cardiology, Koto Memorial Hospital. 22. Department of Cardiology, Hirakata Kohsai Hospital.
Abstract
BACKGROUND: Differences in the clinical characteristics and outcomes of venous thromboembolisms (VTEs) based on different clinical situations surrounding the onset might be important for directing appropriate treatment strategies, but have not yet been appropriately evaluated. Methods and Results: The COMMAND VTE Registry is a multicenter registry enrolling 3,027 consecutive patients with acute symptomatic VTEs in Japan between January 2010 and August 2014. We divided the study population into 3 groups: Out-of-hospital onset (n=2,308), In-hospital onset with recent surgery (n=310), and In-hospital onset without recent surgery (n=374). Active cancer was most prevalent in the In-hospital onset without recent surgery group, and least in the Out-of-hospital onset group (Out-of-hospital onset group: 20%, In-hospital onset with recent surgery group: 26%, and In-hospital onset without recent surgery group: 38%, P<0.001). The cumulative 5-year incidence of recurrent VTEs did not significantly differ across the 3 groups (11.4%, 5.8%, and 8.7%, respectively; P=0.11). The cumulative 5-year incidences of major bleeding and all-cause death were highest in the In-hospital onset without recent surgery group (11.1%, 8.5%, and 23.3%, P<0.001; 26.8%, 24.9%, and 48.4%, P<0.001, respectively). CONCLUSIONS: In the real-world VTE registry, the clinical characteristics and long-term outcomes substantially differed according to the clinical situation of VTE onset, suggesting the need for different treatment strategies for VTEs in different clinical settings.
BACKGROUND: Differences in the clinical characteristics and outcomes of venous thromboembolisms (VTEs) based on different clinical situations surrounding the onset might be important for directing appropriate treatment strategies, but have not yet been appropriately evaluated. Methods and Results: The COMMAND VTE Registry is a multicenter registry enrolling 3,027 consecutive patients with acute symptomatic VTEs in Japan between January 2010 and August 2014. We divided the study population into 3 groups: Out-of-hospital onset (n=2,308), In-hospital onset with recent surgery (n=310), and In-hospital onset without recent surgery (n=374). Active cancer was most prevalent in the In-hospital onset without recent surgery group, and least in the Out-of-hospital onset group (Out-of-hospital onset group: 20%, In-hospital onset with recent surgery group: 26%, and In-hospital onset without recent surgery group: 38%, P<0.001). The cumulative 5-year incidence of recurrent VTEs did not significantly differ across the 3 groups (11.4%, 5.8%, and 8.7%, respectively; P=0.11). The cumulative 5-year incidences of major bleeding and all-cause death were highest in the In-hospital onset without recent surgery group (11.1%, 8.5%, and 23.3%, P<0.001; 26.8%, 24.9%, and 48.4%, P<0.001, respectively). CONCLUSIONS: In the real-world VTE registry, the clinical characteristics and long-term outcomes substantially differed according to the clinical situation of VTE onset, suggesting the need for different treatment strategies for VTEs in different clinical settings.