Baseline VTE risk factors significantly impacted the 5-year incidence of recurrent VTE, ranging from 2.6% in the major transient risk group to 12.1% in the non-malignant persistent group (P<0.001).
Cohort (n=5,197)
Yes
How do anticoagulation strategies and long-term VTE recurrence vary among different risk groups of patients with acute symptomatic VTE in the DOAC era?
In the DOAC era, long-term VTE recurrence and bleeding risks vary significantly based on baseline risk factors, highlighting the need for detailed risk stratification to guide anticoagulation strategies.
p-value: p=<0.001
BACKGROUND: There has been limited data on anticoagulation strategies and long-term recurrence in patients with venous thromboembolism (VTE) in the era of direct oral anticoagulant (DOAC). METHODS: The COMMAND VTE Registry-2 is a multicenter retrospective cohort study enrolling 5197 consecutive patients with acute symptomatic VTE between January 2015 and August 2020 among 31 centers in Japan. In this primary report, the entire cohort was divided into 5 groups; major transient risk factors (N = 475, 9.1%), minor transient risk factors (N = 788, 15%), unprovoked (N = 1913, 37%), non-malignant persistent risk factors (N = 514, 9.9%), and active cancer (N = 1507, 29%) groups. RESULTS: DOACs were administered in 79% of patients who received oral anticoagulants. Discontinuation of anticoagulant at 1 year was most frequent in the major transient risk factors group (57.2%, 46.3%, 29.1%, 32.0%, and 45.6%). The cumulative 5-year incidence of recurrent VTE was lowest in the major transient risk factors group (2.6%, 6.4%, 11.0%, 12.1%, and 10.1%, P < 0.001). The cumulative 5-year incidence of major bleeding was highest in the active cancer group (9.8%, 11.4%, 11.0%, 15.5%, and 20.4%, P < 0.001). After discontinuation of anticoagulation therapy, the cumulative 5-year incidence of recurrent VTE was highest in the unprovoked group (3.3%, 11.0%, 24.9%, 17.5%, and 11.8%, P < 0.001). CONCLUSIONS: In this large real-world VTE registry, anticoagulation strategies and long-term recurrence widely differed depending on the baseline characteristics. Detailed risk stratifications of recurrent VTE could be useful for decision-making of anticoagulation strategies, whereas the bleeding-risk assessment might be especially important in the era of DOAC. CLINICAL TRIAL REGISTRATION: URL: http://www.umin.ac.jp/ctr/index.htm Unique identifier: UMIN000044816.
Kaneda et al. (Fri,) conducted a cohort in Acute symptomatic venous thromboembolism (VTE) (n=5,197). Baseline VTE risk factors (major transient, minor transient, unprovoked, non-malignant persistent, active cancer) vs. Across groups was evaluated on Cumulative 5-year incidence of recurrent VTE (p=<0.001). Baseline VTE risk factors significantly impacted the 5-year incidence of recurrent VTE, ranging from 2.6% in the major transient risk group to 12.1% in the non-malignant persistent group (P<0.001).