Cancer-associated venous thromboembolism in the direct oral anticoagulants era: Insight from the COMMAND VTE Registry-2.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
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Chatani Ryuki, Yamashita Yugo, Morimoto Takeshi, Mushiake Kazunori, Kadota Kazushige, Kaneda Kazuhisa, Nishimoto Yuji, Ikeda Nobutaka, Kobayashi Yohei, Ikeda Satoshi, Kim Kitae, Inoko Moriaki, Takase Toru, Tsuji Shuhei, Oi Maki, Takada Takuma, Otsui Kazunori, Sakamoto Jiro, Ogihara Yoshito, Inoue Takeshi, Usami Shunsuke, Chen Po-Min, Togi Kiyonori, Koitabashi Norimichi, Hiramori Seiichi, Doi Kosuke, Mabuchi Hiroshi, Tsuyuki Yoshiaki, Murata Koichiro, Takabayashi Kensuke, Nakai Hisato, Sueta Daisuke, Shioyama Wataru, Dohke Tomohiro, Nishikawa Ryusuke, Kimura Takeshi, COMMAND VTE Registry-2 Investigators
Аннотация
OBJECTIVES: To investigate the status of cancer-associated VTE in the DOAC era.
METHODS: This multicenter, retrospective cohort study among 31 centers in Japan between 2015 and 2020 enrolled 5197 consecutive patients with acute symptomatic VTE, who were divided into 1507 patients (29 %) with active cancer and 3690 patients (71 %) without.
RESULTS: The cumulative 3-year rate of anticoagulation discontinuation was significantly higher in patients with active cancer than in those without (62.7 % vs. 59.1 %, P < 0.001). The cumulative 5-year incidence of recurrent VTE was higher in patients with active cancer than in those without (10.1 % vs. 9.1 %, P = 0.01), however, after adjusting for the confounders and competing risk of mortality, the excess risk of the active cancer group relative to the no active cancer group was no longer significant (HR: 0.95, 95 % CI: 0.73-1.24). The cumulative 5-year incidence of major bleeding was much higher in the active cancer group (20.4 % vs. 11.6 %, P < 0.001). Even after adjusting for the confounders and competing risk of mortality, the risk of the active cancer group relative to the no active cancer group remained significant (HR: 1.36, 95 % CI: 1.11-1.66).
CONCLUSIONS: The current large real-world registry revealed that the risk of major bleeding was still higher in patients with active cancer than in those without, leading to the frequent anticoagulation discontinuation, which has been still a huge challenge to overcome in the DOAC era.