Transition of management strategies and long-term outcomes in cancer-associated venous thromboembolism from the warfarin era to the direct oral anticoagulant era.

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 UNIQUE IDENTIFIER: UMIN000044816.

Chatani R ，Yamashita Y ，Morimoto T ，Kaneda K ，Mushiake K ，Kadota K ，Nishimoto Y ，Ikeda N ，Kobayashi Y ，Ikeda S ，Kim K ，Inoko M ，Takase T ，Tsuji S ，Oi M ，Kimura T ，COMMAND VTE Registry-2 Investigators ... -  《-》

Temporal Changes in Long-Term Outcomes of Venous Thromboembolism From the Warfarin Era to the Direct Oral Anticoagulant Era.

Kaneda K ，Yamashita Y ，Morimoto T ，Chatani R ，Nishimoto Y ，Ikeda N ，Kobayashi Y ，Ikeda S ，Kim K ，Inoko M ，Takase T ，Tsuji S ，Oi M ，Takada T ，Otsui K ，Sakamoto J ，Ogihara Y ，Inoue T ，Usami S ，Chen PM ，Togi K ，Koitabashi N ，Hiramori S ，Doi K ，Mabuchi H ，Tsuyuki Y ，Murata K ，Takabayashi K ，Nakai H ，Sueta D ，Shioyama W ，Dohke T ，Nishikawa R ，Ono K ，Kimura T ... -  《Journal of the American Heart Association》

Direct oral anticoagulant-associated bleeding complications in patients with gastrointestinal cancer and venous thromboembolism.

Direct oral anticoagulants (DOACs) have become widely used for cancer-associated venous thromboembolism (VTE). However, DOAC-associated bleeding complications remain challenging, especially in patients with gastrointestinal (GI) cancer. This study aimed to compare the bleeding outcomes between patients with upper or lower GI cancers and those without GI cancer. Using the COMMAND VTE Registry-2 database, which is a multicenter registry enrolling 5197 consecutive acute symptomatic VTE patients among 31 centers in Japan between January 2015 and August 2020, we identified 1149 active cancer patients with DOACs (upper GI cancer: N = 88; lower GI cancer: N = 114; non-GI cancer: N = 947). The primary outcome was major bleeding during anticoagulation therapy, which was evaluated in the competing risk regression model. The upper GI cancer group had a lower mean body weight, and most often had anemia. The cumulative 5-year incidence of major bleeding was higher in the upper GI cancer group (upper GI cancer: 22.4 %, lower GI cancer: 15.4 %, and non-GI cancer: 11.6 %, P = 0.015). The most frequent major bleeding site in the upper GI cancer group was the upper GI (53 %), followed by the lower GI (24 %). After adjusting for the confounders, the excess risk in upper GI cancer relative to non-GI cancer remained significant for major bleeding (adjusted subhazard ratio, 2.25; 95 %CI, 1.31-3.87, P = 0.003), but that in lower GI cancer was insignificant. Upper GI cancer, but not lower GI cancer, as compared to non-GI cancer was associated with a higher risk for major bleeding during anticoagulation therapy with DOACs. URL: http://www.umin.ac.jp/ctr/index.htm Unique identifier: UMIN000044816.

Nishimoto Y ，Yamashita Y ，Morimoto T ，Chatani R ，Kaneda K ，Ikeda N ，Kobayashi Y ，Ikeda S ，Kim K ，Inoko M ，Takase T ，Sato Y ，Watanabe T ，Yamada T ，Fukunami M ，Kimura T ，COMMAND VTE Registry-2 Investigators ... -  《-》

Anticoagulation strategies and long-term recurrence in patients with venous thromboembolism in the era of direct oral anticoagulants.

Kaneda K ，Yamashita Y ，Morimoto T ，Chatani R ，Nishimoto Y ，Ikeda N ，Kobayashi Y ，Ikeda S ，Kim K ，Inoko M ，Takase T ，Tsuji S ，Oi M ，Takada T ，Otsui K ，Kimura T ，COMMAND VTE Registry-2 Investigators ... -  《-》

Comparing DOAC and warfarin outcomes in an obese population using the 'real-world' Michigan Anticoagulation Quality Improvement Initiative (MAQI(2)) registry.

Ardeshna N ，Feldeisen T ，Kong X ，Haymart B ，Kaatz S ，Ali M ，Barnes GD ，Froehlich JB ... -  《-》