TAKADA Takuma    Department   Research Institutes and Facilities, Research Institutes and Facilities    Position   Assistant Professor
Language	English
Title	Direct Oral Anticoagulants-Associated Bleeding Complications in Patients with Gastrointestinal Cancer and Venous Thromboembolism: 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	Yuji Nishimoto, Tetsuya Watanabe, Takahisa Yamada, Masatake Fukunami, Ryuki Chatani, Kazuhisa Kaneda, Nobutaka Ikeda, Yohei Kobayashi, Satoshi Ikeda, Kite Kim, Toru Takase, Shuhei Tsuji, Maki Ohi, Takuma Takada, Kazunori Otsui, Jiro Sakamoto, Yoshito Ogihara, Yukihito Satoh, Yugo Yamashita
Date	2023/03/11
Venue (city and name of the country)	福岡
Summary	Background: Direct oral anticoagulants (DOACs) have become first-line anticoagulants for cancer-associated venous thromboembolism (VTE) in Japan. However, DOACs-associated bleeding complications remain challenging in patients with gastrointestinal (GI) cancer. We aimed to compare bleeding outcomes between patients with and without GI cancer. Methods: Using the COMMAND VTE Registry-2 database, which is a multicenter registry enrolling 5,197 consecutive acute symptomatic VTE patients among 31 centers in Japan between January 2015 and August 2020, we identified VTE patients with active cancer who received DOACs and divided those into GI cancer and no GI cancer groups. The primary outcome measure was ISTH major bleeding during anticoagulation therapy. The Fine and Gray competing risk regression was performed to estimate the risk of GI cancer for the primary outcome. Results: Of 1,197 eligible patients, 196 (16%) had GI cancer. The GI cancer group were less likely to be women and more frequently had distant metastases. The cumulative 5-year incidence of major bleeding tended to be higher in the GI cancer group than the no GI cancer group (38% versus 19%, P=0.06). The most frequent major bleeding site in the GI cancer group was upper GI (41%), followed by lower GI (33%) and urinary (11%). GI cancer as compared to no GI cancer was significantly associated with a higher adjusted risk for major bleeding (hazard ratio: 1.55, 95% confidence interval: 1.02-2.37, P=0.04). Conclusions: In the Era of DOACs for VTE, patients with GI cancer showed a higher risk of major bleeding than those without, which could be still unsolved issues for cancer-associated VTE.