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Effectiveness and Safety of Direct Oral Anticoagulants vs. Warfarin and Recurrence After Discontinuation in Patients With Acute Venous Thromboembolism in the Real World.
Hara, Nobuhiro; Lee, Tetsumin; Nozato, Toshihiro; Terui Matsuyama, Mao; Okata, Shinichiro; Nagase, Masashi; Mitsui, Kentaro; Nitta, Giichi; Watanabe, Keita; Miyazaki, Ryoichi; Nagamine, Sho; Kaneko, Masakazu; Nakamura, Tomofumi; Nagata, Yasutoshi; Miyamoto, Takamichi; Obayashi, Toru; Ashikaga, Takashi.
Afiliación
  • Hara N; Department of Cardiology, Japanese Red Cross Musashino Hospital.
  • Lee T; Department of Cardiology, Japanese Red Cross Musashino Hospital.
  • Nozato T; Department of Cardiology, Japanese Red Cross Musashino Hospital.
  • Terui Matsuyama M; Department of Cardiology, Japanese Red Cross Musashino Hospital.
  • Okata S; Department of Cardiology, Japanese Red Cross Musashino Hospital.
  • Nagase M; Department of Cardiology, Japanese Red Cross Musashino Hospital.
  • Mitsui K; Department of Cardiology, Japanese Red Cross Musashino Hospital.
  • Nitta G; Department of Cardiology, Japanese Red Cross Musashino Hospital.
  • Watanabe K; Department of Cardiology, Japanese Red Cross Musashino Hospital.
  • Miyazaki R; Department of Cardiology, Japanese Red Cross Musashino Hospital.
  • Nagamine S; Department of Cardiology, Japanese Red Cross Musashino Hospital.
  • Kaneko M; Department of Cardiology, Japanese Red Cross Musashino Hospital.
  • Nakamura T; Department of Cardiology, Japanese Red Cross Musashino Hospital.
  • Nagata Y; Department of Cardiology, Japanese Red Cross Musashino Hospital.
  • Miyamoto T; Department of Cardiology, Japanese Red Cross Musashino Hospital.
  • Obayashi T; Department of Cardiology, Japanese Red Cross Musashino Hospital.
  • Ashikaga T; Department of Cardiology, Japanese Red Cross Musashino Hospital.
Circ J ; 86(6): 923-933, 2022 05 25.
Article en En | MEDLINE | ID: mdl-34645732
BACKGROUND: The efficacy of direct oral anticoagulants (DOACs) compared with warfarin for the treatment of venous thromboembolism (VTE), and the recurrence of VTE after discontinuation of anticoagulation therapy in research are limited.Methods and Results: This retrospective study enrolled 893 patients with acute VTE between 2011 and 2019. The cohort was divided into the transient risk, unprovoked, continued cancer treatment, and cancer remission groups. The following were compared between DOACs and warfarin: composite outcome of all-cause death, VTE recurrence, bleeding and composite outcome of VTE-related death, recurrence and bleeding. In the continued cancer treatment group, more bleeding was seen in warfarin-treated patients than in patients treated with DOACs (53.2% vs. 31.2%, [P=0.048]). In addition, composite outcome of VTE-related death and recurrence after discontinuation of anticoagulation therapy (n=369) was evaluated. The continued cancer treatment group (multivariate analysis: HR: 3.62, 95% CI: 1.84-7.12, P<0.005) and bleeding-related discontinuation of therapy (HR: 2.60, 95% CI: 1.32-5.13, P=0.006) were independent predictors of the event after discontinuation of anticoagulation therapy. VTE recurrence after discontinuation of anticoagulation therapy in the cancer remission group was 1.6% and a statistically similar occurrence was found in the transient risk group (12.4%) (P=0.754). CONCLUSIONS: DOACs may decrease bleeding incidence in patients continuing to receive cancer treatment. In patients with bleeding-related discontinuation of anticoagulation therapy, VTE recurrence may increase. Discontinuation of anticoagulant therapy might be a treatment option in patients who have completed their cancer treatment.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Trombosis de la Vena / Tromboembolia Venosa Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Circ J Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA Año: 2022 Tipo del documento: Article Pais de publicación: Japón
Texto completo
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Imprimir
XML
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Trombosis de la Vena / Tromboembolia Venosa Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Circ J Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA Año: 2022 Tipo del documento: Article Pais de publicación: Japón