TAKADA Takuma    Department   Research Institutes and Facilities, Research Institutes and Facilities    Position   Assistant Professor
Language	English
Title	Anticoagulation Strategies and Clinical Outcomes of Venous Thromboembolism in the Era of Direct Oral Anticoagulant: 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	Panelist at Symposium/Workshop (Appointed)
Publisher and common publisher	Kazuhisa Kaneda, Yugo Yamashita, Takeshi Morimoto, Ryuki Chatani, Yuji Nishimoto, Nobutaka Ikeda, Yohei Kobayashi, Satoshi Ikeda, Kite Kim, Toru Takase, Shuhei Tsuji, Maki Ohi, Takuma Takada, Kazunori Otsui, Jiro Sakamoto, Ryusuke Nishikawa, Takeshi Kimura
Date	2023/03/11
Venue (city and name of the country)	福岡
Summary	Background: There has been limited data on the real-world anticoagulation strategies and long-term clinical outcomes of venous thromboembolism (VTE) in the current Era of direct oral anticoagulant (DOAC). Methods and Results: The COMMAND VTE Registry-2 is a multicenter historical cohort study enrolling 5,197 consecutive patients with acute symptomatic VTE between January 2015 and August 2020 among 31 centers in Japan. In this primary report from the registry, the entire cohort was divided into 5 groups based on the risk stratification by ISTH recommendations; major transient risk (N=475, 9%), minor transient risk (N=788, 15%), unprovoked (N=1,913, 37%), non-malignant persistent risk (N=514, 10%), and active cancer (N=1,507, 29%) groups. Patients who were treated with DOAC as oral anticoagulation therapy accounted for 4128 (79.4%), and the discontinuation rates of anticoagulation therapy were widely different among the groups (57.2%, 46.3%, 29.1%, 32.0%, and 45.6% at 1-year, P<0.001). The cumulative incidence of recurrent VTE was lowest in the major transient risk group (2.6%, 6.4%, 11.0%, 12.1%, and 10.1% at 5-year, P<0.001), while the cumulative incidence of major bleeding was highest in the active cancer group (9.8%, 11.4%, 11.0%, 15.5%, 20.4% at 5-year, P<0.001). The cumulative incidence of all-cause death was markedly higher in the active cancer group (13.9%, 19.5%, 15.9%, 24.6%, and 64.8% at 5-year, P<0.001). Conclusions: In this large real-world VTE registry, the risks of clinical outcomes widely differed depending on baseline characteristics, and detailed risk stratifications of recurrent VTE could be useful for decision-making of anticoagulation strategies, whereas the bleeding-risk assessment might be also important even in the Era of DOAC.