Jiro Sakamoto1, Yugo Yamashita2, Takeshi Morimoto3, 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, Syunsuke Saga17, Yuji Nishimoto17, Tomoki Sasa18, Minako Kinoshita19, Kiyonori Togi20, Hiroshi Mabuchi21, Kensuke Takabayashi22, Yusuke Yoshikawa2, Hiroki Shiomi2, Takao Kato2, Takeru Makiyama2, Koh Ono2, Toshihiro Tamura1, Yoshihisa Nakagawa23, Takeshi Kimura2. 1. Department of Cardiology, Tenri Hospital. 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, Kindai 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, Hyogo Prefectural Amagasaki General Medical Center. 18. Department of Cardiology, Kishiwada City Hospital. 19. Department of Cardiology, Nishikobe Medical Center. 20. Division of Cardiology, Nara Hospital, Kindai University Faculty of Medicine. 21. Department of Cardiology, Koto Memorial Hospital. 22. Department of Cardiology, Hirakata Kohsai Hospital. 23. Department of Cardiovascular Medicine, Shiga University of Medical Science.
Abstract
BACKGROUND: There is a paucity of data on the management and prognosis of cancer-associated venous thromboembolism (VTE), leading to uncertainty about optimal management strategies.Methods and Results: The COMMAND VTE Registry is a multicenter registry enrolling 3,027 consecutive acute symptomatic VTE patients in Japan between 2010 and 2014. We divided the entire cohort into 3 groups: active cancer (n=695, 23%), history of cancer (n=243, 8%), and no history of cancer (n=2089, 69%). The rate of anticoagulation discontinuation was higher in patients with active cancer (43.5%, 27.0%, and 27.0%, respectively, at 1 year, P<0.001). The cumulative 5-year incidences of recurrent VTE, major bleeding, and all-cause death were higher in patients with active cancer (recurrent VTE: 17.7%, 10.2%, and 8.6%, P<0.001; major bleeding: 26.6%, 8.8%, and 9.3%, P<0.001; all-cause death: 73.1%, 28.6%, 14.6%, P<0.001). Among the 4 groups classified according to active cancer status, the cumulative 1-year incidence of recurrent VTE was higher in the metastasis group (terminal stage group: 6.4%, metastasis group: 22.1%, under chemotherapy group: 10.8%, and other group: 5.8%, P<0.001). CONCLUSIONS: In a current real-world VTE registry, patients with active cancer had higher risk for VTE recurrence, bleeding, and death, with variations according to cancer status, than patients without active cancer. Anticoagulation therapy was frequently discontinued prematurely in patients with active cancer in discordance with current guideline recommendations.
BACKGROUND: There is a paucity of data on the management and prognosis of cancer-associated venous thromboembolism (VTE), leading to uncertainty about optimal management strategies.Methods and Results: The COMMAND VTE Registry is a multicenter registry enrolling 3,027 consecutive acute symptomatic VTEpatients in Japan between 2010 and 2014. We divided the entire cohort into 3 groups: active cancer (n=695, 23%), history of cancer (n=243, 8%), and no history of cancer (n=2089, 69%). The rate of anticoagulation discontinuation was higher in patients with active cancer (43.5%, 27.0%, and 27.0%, respectively, at 1 year, P<0.001). The cumulative 5-year incidences of recurrent VTE, major bleeding, and all-cause death were higher in patients with active cancer (recurrent VTE: 17.7%, 10.2%, and 8.6%, P<0.001; major bleeding: 26.6%, 8.8%, and 9.3%, P<0.001; all-cause death: 73.1%, 28.6%, 14.6%, P<0.001). Among the 4 groups classified according to active cancer status, the cumulative 1-year incidence of recurrent VTE was higher in the metastasis group (terminal stage group: 6.4%, metastasis group: 22.1%, under chemotherapy group: 10.8%, and other group: 5.8%, P<0.001). CONCLUSIONS: In a current real-world VTE registry, patients with active cancer had higher risk for VTE recurrence, bleeding, and death, with variations according to cancer status, than patients without active cancer. Anticoagulation therapy was frequently discontinued prematurely in patients with active cancer in discordance with current guideline recommendations.