TAKADA Takuma    Department   Research Institutes and Facilities, Research Institutes and Facilities    Position   Assistant Professor
Language	English
Title	Risk Factors of Bleeding during Anticoagulation Therapy for Cancer-associated Venous Thromboembolism in the DOAC Era: 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	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
Date	2023/03/10
Venue (city and name of the country)	福岡
Summary	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.