Transition of management strategies and long-term outcomes in cancer-associated venous thromboembolism from the warfarin era to the direct oral anticoagulant era.
In: European Journal of Internal Medicine, Jg. 123 (2024-05-01), S. 72-80
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Zugriff:
• There have been still limited data on the transition of management strategies and clinical outcomes after introduction of direct oral anticoagulant (DOAC) for cancer-associated venous thromboembolism (VTE) in the real-world clinical practice. • In the current historical comparison of cancer-associated VTE between the 2 large real-world registries, there was a striking change in the treatment strategies with decreased risks of recurrent VTE and major bleeding in the DOAC era (COMAAND VTE Registry-2) compared with those in the warfarin era (COMAAND VTE Registry-1). • The risks of recurrent VTE has decreased significantly with the transition to the DOAC era, while there seemed to be unmet needs of clinically relevant nonmajor bleeding, DOAC-related gastrointestinal bleeding, and home treatment for pulmonary embolism patients with cancer. There have been still limited data on the transition of management strategies and clinical outcomes after introduction of direct oral anticoagulant (DOAC) for cancer-associated venous thromboembolism (VTE) in the real-world clinical practice. Using the 2 series of multicenter COMMAND VTE registries in Japan enrolling consecutive patients with acute symptomatic VTE, we compared 695 patients with cancer-associated VTE in the Registry-1 of the warfarin era and 1507 patients in the Registry-2 of the DOAC era. Regarding oral anticoagulation therapy, 576 patients (82.9 %) in the Registry-1 received warfarin, whereas 1119 patients (79.6 %) in the Registry-2 received DOACs. The cumulative 3-year incidence of discontinuation of anticoagulation was not significantly different between the 2 registries (56.7 % vs. 62.7 %, P = 0.11). The cumulative 5-year incidence of recurrent VTE was significantly lower in the Registry-2 than in the Registry-1 (17.7 % vs. 10.1 %, P < 0.001). The cumulative 5-year incidence of major bleeding was significantly lower in the Registry-2 than in the Registry-1 (26.6 % vs. 20.4 %, P = 0.045). The proportion of gastrointestinal bleeding numerically increased from the Registry-1 to the Registry-2 (46.7 % and 49.5 %), whereas that of intracranial bleeding numerically decreased from the Registry-1 to the Registry-2 (17.1 % and 14.1 %). In the current historical comparison of cancer-associated VTE between the 2 large real-world registries, there was a striking change in the treatment strategies with decreased risks of recurrent VTE and major bleeding in the DOAC era compared with those in the warfarin era, while there seemed to be unmet needs of DOAC-related gastrointestinal bleeding. URL: http://www.umin.ac.jp/ctr/index.htm UMIN000044816. We compared the management strategies and clinical outcomes of patients with cancer-associated VTE between the COMMAND VTE Registry-1 (Warfarin era) and Registry-2 (DOAC era). The lower adjusted risk of the Registry-2 relative to the Registry-1 was significant for recurrent VTE, but not for major bleeding. CRNMB, clinically relevant nonmajor bleeding; DOAC, direct oral anticoagulant; VTE, venous thromboembolism; CI, confidence interval; HR, hazard ratio [Display omitted] [ABSTRACT FROM AUTHOR]
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Transition of management strategies and long-term outcomes in cancer-associated venous thromboembolism from the warfarin era to the direct oral anticoagulant era.
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Autor/in / Beteiligte Person: | Chatani, Ryuki ; Yamashita, Yugo ; Morimoto, Takeshi ; Kaneda, Kazuhisa ; Mushiake, Kazunori ; Kadota, Kazushige ; Nishimoto, Yuji ; Ikeda, Nobutaka ; Kobayashi, Yohei ; Ikeda, Satoshi ; Kim, Kitae ; Inoko, Moriaki ; Takase, Toru ; Tsuji, Shuhei ; Oi, Maki ; Kimura, Takeshi |
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Zeitschrift: | European Journal of Internal Medicine, Jg. 123 (2024-05-01), S. 72-80 |
Veröffentlichung: | 2024 |
Medientyp: | academicJournal |
ISSN: | 0953-6205 (print) |
DOI: | 10.1016/j.ejim.2024.01.012 |
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