TAKADA Takuma    Department   Research Institutes and Facilities, Research Institutes and Facilities    Position   Assistant Professor
Language	English
Title	Initial Anticoagulation Strategy in Pulmonary Embolism Patients with Right Ventricular Dysfunction and Elevated Troponin Levels: From the COMMAND VTE Registry-2
Conference	第87回日本循環器学会学術集会
Conference Type	Nationwide Conferences
Presentation Type	Speech
Lecture Type	General
Publisher and common publisher	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
Date	2023/03/12
Venue (city and name of the country)	福岡
Summary	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.