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September 19, 2019Circulation JournalOpen Access

Cancer-Associated Venous Thromboembolism in the Real World ― From the COMMAND VTE Registry ―

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Key result

Active cancer in patients with acute symptomatic venous thromboembolism was associated with a significantly higher 5-year risk of recurrent VTE (adjusted HR 2.94) compared to no history of cancer.

Why the study?

Data on the management and prognosis of cancer-associated venous thromboembolism are limited, leading to uncertainty regarding optimal management strategies.

Does active cancer status increase the risk of recurrent VTE, major bleeding, and death in patients with acute symptomatic VTE?

Population

3,027 consecutive acute symptomatic VTE patients in Japan

Comparison

Active cancer vs history of cancer vs no history of cancer

Design

Multicenter registry

Follow-up

5 years

Authors

JSJiro SakamotoYYYugo YamashitaTMTakeshi Morimoto

Discussion

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Member takes

Overview

May support extended anticoagulation in active cancer VTE; leaves open optimal duration via RCTs.

Study Design

Type

Cohort (n=3,027)

Multicenter

Yes

Structured PICO

Does active cancer status increase the risk of recurrent VTE, major bleeding, and death in patients with acute symptomatic VTE?

P
Population
3,027 consecutive patients with acute symptomatic venous thromboembolism in Japan, followed for a median of 1,218 days to evaluate the impact of cancer status on clinical outcomes.
C
Comparator
No history of cancer
O
Outcome
Recurrent VTE, major bleeding, and all-cause death at 5 yearshard clinical

Main Result

Hazard Ratio: 2.94 (95% CI 2.2–3.92)

Absolute Event Rate: 17.7% vs 8.6%

p-value: p=<0.001

In a real-world Japanese registry, VTE patients with active cancer had substantially higher risks of VTE recurrence, major bleeding, and mortality compared to those without cancer, and frequently discontinued anticoagulation prematurely.

Limitations

  • Observational cohort study design with management strategies left to attending physicians' discretion
  • Demographics and practice patterns in Japan may differ from those outside Japan
  • Low-molecular-weight heparin for VTE was not covered by Japanese national insurance, so warfarin was mostly used
  • Cancer treatments, including platinum-based chemotherapy and molecular targeted therapy, were not evaluated
  • Cancer relapse-free survival time in patients with a history of cancer was not evaluated
  • Cancer status was not evaluated after the index VTE event

Cite This Study

Sakamoto et al. (2019) conducted a cohort in Acute symptomatic venous thromboembolism (n=3,027). Active cancer vs. No history of cancer was evaluated on Recurrent VTE at 5 years (HR 2.94, 95% CI 2.20-3.92, p=<0.001). Active cancer in patients with acute symptomatic venous thromboembolism was associated with a significantly higher 5-year risk of recurrent VTE (adjusted HR 2.94) compared to no history of cancer.

synapsesocial.com/papers/6a980d4a713b4e110fe350dahttps://doi.org/10.1253/circj.cj-19-0515
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Anticoagulation Therapy for Venous Thromboembolism in the Real World　― From the COMMAND VTE Registry ―2018 · 149 citations
  2. 2Predicting recurrences or major bleeding in cancer patients with venous thromboembolism2008 · 171 citations
  3. 3Recurrent thromboembolism and major bleeding during oral anticoagulant therapy in patients with solid cancer: findings from the RIETE registry2008 · 51 citations
  4. 4Stroke and Cancer2012 · 257 citations
  5. 5Edoxaban versus Warfarin for the Treatment of Symptomatic Venous Thromboembolism2013 · 1,883 citations