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TAKADA Takuma
Department Research Institutes and Facilities, Research Institutes and Facilities Position Assistant Professor |
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| Article types | Original article |
| Language | English |
| Peer review | Peer reviewed |
| Title | Fragility and long-term clinical outcomes in patients with venous thromboembolism receiving direct oral anticoagulants: From the COMMAND VTE REGISTRY-2. |
| Journal | Formal name：Thrombosis research Abbreviation：Thromb Res ISSN code：18792472/00493848 |
| Domestic / Foregin | Foregin |
| Volume, Issue, Page | 236,pp.191-200 |
| Author and coauthor | Ogihara Yoshito, Yamashita Yugo, Morimoto Takeshi, Chatani Ryuki, Kaneda Kazuhisa, Nishimoto Yuji, Ikeda Nobutaka, Kobayashi Yohei, Ikeda Satoshi, Kim Kitae, Inoko Moriaki, Takase Toru, Tsuji Shuhei, Oi Maki, Takada Takuma, Otsui Kazunori, Sakamoto Jiro, Inoue Takeshi, Usami Shunsuke, Chen Po-Min, Togi Kiyonori, Koitabashi Norimichi, Hiramori Seiichi, Doi Kosuke, Mabuchi Hiroshi, Tsuyuki Yoshiaki, Murata Koichiro, Takabayashi Kensuke, Nakai Hisato, Sueta Daisuke, Shioyama Wataru, Dohke Tomohiro, Sato Toru, Nishikawa Ryusuke, Kimura Takeshi, Dohi Kaoru, |
| Publication date | 2024/02 |
| Summary | INTRODUCTION:There is limited data on the safety of direct oral anticoagulants (DOACs) in fragile patients with venous thromboembolism (VTE).MATERIALS AND METHODS:We used the COMMAND VTE Registry-2 enrolling patients with acute symptomatic VTE. The study population consisted of 3928 patients receiving DOACs, who were divided into fragile (2136 patients) and non-fragile groups (1792 patients). Fragility was defined as patients of age ≥ 75 years, creatinine clearance level ≤ 50 ml/min, and/or body weight ≤ 50 kg.RESULTS:The fragile group significantly more often received reduced doses of DOACs compared to the non-fragile group (51 % and 19 %, P < 0.001). The cumulative 5-year incidence of major bleeding was numerically higher in the fragile group than the non-fragile group (15.0 % and 11.1 %, P = 0.052), even with no significant excess risk after adjusting for confounders (HR 1.03, 95%CI 0.81-1.31, P = 0.78). The cumulative 5-year incidence of clinically relevant bleeding was significantly higher in the fragile group than the non-fragile group (28.6 % and 19.6 %, P < 0.001), even after adjusting for confounders (HR 1.28, 95%CI 1.08-1.53, P = 0.005). There was no significant difference in cumulative 5-year incidence of recurrent VTE between the groups (9.6 % and 8.9 %, P = 0.68), which was consistent after adjusting for confounders (HR 1.13, 95%CI 0.84-1.51, P = 0.41).CONCLUSIONS:Among VTE patients receiving DOACs, fragile patients were associated with a numerically higher rate of major bleeding and a significantly increased risk of clinically relevant bleeding, but not an increased risk of recurrent VTE. |
| DOI | 10.1016/j.thromres.2024.02.023 |
| PMID | 38461613 |