タカダ　タクマ   Takada Takuma   髙田　卓磨    所属   研究施設 研究施設    職種   非常勤講師
言語種別	英語
発表タイトル	Initial Anticoagulation Strategy in Pulmonary Embolism Patients with Right Ventricular Dysfunction and Elevated Troponin Levels: From the COMMAND VTE Registry-2
会議名	第87回日本循環器学会学術集会
学会区分	全国規模の学会
発表形式	口頭
講演区分	一般
発表者・共同発表者	Ryo Shigeno, Kite Kim, Ryuki Chatani, Kazuhisa Kaneda, Yuji Nishimoto, Nobutaka Ikeda, Yohei Kobayashi, Satoshi Ikeda, Toru Takase, Shuhei Tsuji, Maki Ohi, Takuma Takada, Kazunori Otsui, Jiro Sakamoto, Yoshito Ogihara, Yugo Yamashita, Yutaka Furukawa
発表年月日	2023/03/12
開催地 （都市, 国名）	福岡
概要	Background: Direct oral anticoagulants (DOACs) have been shown to be non-inferior compared with the combination of heparin and vitamin K antagonist in patients with pulmonary embolism (PE). However, the efficacy and safety of initial anticoagulation with DOAC in patients with PE who have right ventricular dysfunction and elevated cardiac troponin levels are not well investigated. Methods: The COMMAND VTE Registry-2 is a multicenter registry enrolling 5197 consecutive acute symptomatic venous thromboembolism (VTE) patients among 31 centers in Japan between January 2015 and August 2020. The current study population was consisted of 354 normotensive acute PE patients with right ventricular dysfunction and elevated cardiac troponin levels, who were divided into patients who had initial parenteral anticoagulation therapy (n=287) and those who had initial DOAC therapy (n=67). Results: Baseline characteristics were comparable between the 2 groups, except for higher prevalence of previous stroke in initial parenteral group. The 1-year incidence of bleeding events was significantly lower in patients with initial DOAC therapy than in patients with initial parenteral anticoagulation therapy (5.7% vs. 16.6%, p=0.02), whereas the 1-year incidence of VTE recurrence was comparable between the 2 groups (3.9% vs. 3.1%, p=0.40). The 1-year incidence of all-cause mortality was numerically lower in initial DOAC group than in initial parenteral anticoagulation group, without statistical significance (3.7% vs. 11.6%, p=0.24). Conclusions: In normotensive acute PE patients with right ventricular dysfunction and elevated cardiac troponin levels, the initial DOAC therapy as compared with initial parenteral anticoagulation therapy was associated with lower risk of bleeding events and comparable risks of all-cause mortality and VTE recurrence.