タカダ　タクマ   TAKADA Takuma   髙田　卓磨    所属   研究施設 研究施設    職種   助教
言語種別	英語
発表タイトル	Influence of Fragility on Clinical Outcomes in Patients with Venous Thromboembolism and Direct Oral Anticoagulant: 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	Yoshito Ogihara, Kaoru Dohi, Toru Sato, Ryuki Chatani, Kazuhisa Kaneda, Yuji Nishimoto, Nobutaka Ikeda, Yohei Kobayashi, Satoshi Ikeda, Kite Kim, Toru Takase, Shuhei Tsuji, Maki Ohi, Takuma Takada, Kazunori Otsui, Jiro Sakamoto, Yugo Yamashita
発表年月日	2023/03/11
開催地 （都市, 国名）	福岡
概要	Background: Fragile patients are defined as those with one or more of the following criteria: age ≥75 years, creatinine clearance level ≤50 ml/min, and body weight ≤50 kg. Subgroup analyses from randomized control trials comparing direct oral anticoagulant therapy (DOAC) with standard therapy in patients with venous thromboembolism (VTE) have suggested that DOAC could be safe and useful even in fragile patients. However. the data of clinical outcomes in the real world is still lacking. Methods: The COMMAND VTE Registry-2 is a multicenter registry enrolling 5,197 consecutive acute symptomatic VTE patients among 31 centers in Japan between January 2015 and August 2020. The current study population consisted of 3,928 patients with treatment with DAOC and available data of the fragile criteria, who were divided into a fragile group (N=2,136, 45.6%) and a non-fragile group (N=1,792, 54.4%). The primary outcomes measures were major bleeding and recurrent VTE. Results: The cumulative 3-year incidences of major bleeding and recurrent VTE were not significantly different between the fragile and the non-fragile groups (major bleeding: 10.4% vs. 8.8%, p=0.162, respectively; recurrent VTE: 6.8% vs. 6.1%, p=0.406 respectively). After adjusting the confounders, the risks of fragility relative to non-fragility for major bleeding and recurrent VTE remained insignificant (major bleeding: adjusted hazard ratio [HR] 1.03, 95% confidence interval [CI] 0.81 to 1.32, p=0.788; recurrent VTE: adjusted HR 1.09, 95% CI 0.80 to 1.48, p=0.578). Conclusions: In the current large-scale observational study, there were no significant differences in the incidence of major bleeding and recurrent VTE between the fragile and the non-fragile groups with DOAC.