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	Risk Factors of Bleeding during Anticoagulation Therapy for Cancer-associated Venous Thromboembolism in the DOAC Era: 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	Seiichi Hiramori, Yugo Yamashita, 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, Yoshito Ogihara, Kenji Ando
発表年月日	2023/03/10
開催地 （都市, 国名）	福岡
概要	Background: Current guidelines recommend prolonged anticoagulation therapy for patients with cancer-associated venous thromboembolism (VTE), if they are not at a high risk of bleeding during anticoagulation therapy. However, risk factors of bleeding during anticoagulation therapy have not been fully evaluated in the Era of direct oral anticoagulant (DOAC). 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 1,338 cancer-associated VTE patients with anticoagulation therapy beyond the acute phase. We constructed a multivariable Cox proportional hazard model to estimate the hazard ratio (HR) and 95% confidence interval (CI) of the potential risk factors of major bleeding. Results: During a median follow-up period of 479.5 days, major bleeding occurred in 139 patients. The cumulative incidence of major bleeding was 4.3% at 3 months, 9.2% at 1 year, and 11.8% at 2 years. The most frequent bleeding site was gastrointestinal tract (49.6%). The multivariable analysis revealed that history of major bleeding (HR, 2.32; 95%CI, 1.34-4.02, P=0.003), chronic kidney disease (HR, 1.56; 95%CI, 1.03-2.35, P=0.04), anemia (HR, 1.70; 95%CI, 1.08-2.68, P=0.02), metastatic cancer (HR, 2.33; 95%CI, 1.64-3.32, P<0.001), terminal cancer (HR 3.03; 95%CI, 1.81-5.08, P<0.001), and gastrointestinal cancer (HR 1.63; 95%CI, 1.08-2.45, P=0.02) were independently associated with an increased risk of major bleeding. Conclusions: Major bleeding events were common during anticoagulation therapy in the DOAC Era, and history of major bleeding, chronic kidney disease, anemia, metastatic cancer, terminal cancer, and gastrointestinal cancer were the independent risk factors of major bleeding.