Anticoagulation Therapy for Venous Thromboembolism in the Real World - From the COMMAND VTE Registry

Circ J. 2018 Apr 25;82(5):1262-1270. doi: 10.1253/circj.CJ-17-1128. Epub 2018 Mar 23.

Abstract

Background: Venous thromboembolism (VTE) has a long-term risk of recurrence, which can be prevented by anticoagulation therapy.Methods and Results:The COMMAND VTE Registry is a multicenter registry enrolling 3,027 consecutive patients with acute symptomatic VTE between January 2010 and August 2014. The entire cohort was divided into the transient risk (n=855, 28%), unprovoked (n=1,477, 49%), and cancer groups (n=695, 23%). The rate of anticoagulation discontinuation was highest in the cancer group (transient risk: 37.3% vs. unprovoked: 21.4% vs. cancer: 43.5% at 1 year, P<0.001). The cumulative 5-year incidences of recurrent VTE, major bleeding and all-cause death were highest in the cancer group (recurrent VTE: 7.9% vs. 9.3% vs. 17.7%, P<0.001; major bleeding: 9.0% vs. 9.4% vs. 26.6%, P<0.001; and all-cause death: 17.4% vs. 15.3% vs. 73.1%, P<0.001). After discontinuation of anticoagulation therapy, the cumulative 3-year incidence of recurrent VTE was lowest in the transient risk group (transient risk: 6.1% vs. unprovoked: 15.3% vs. cancer: 13.2%, P=0.001). The cumulative 3-year incidence of recurrent VTE beyond 1 year was lower in patients on anticoagulation than in patients off anticoagulation at 1 year in the unprovoked group (on: 3.7% vs. off: 12.2%, P<0.001), but not in the transient risk and cancer groups (respectively, 1.6% vs. 2.5%, P=0.30; 5.6% vs. 8.6%, P=0.44).

Conclusions: The duration of anticoagulation therapy varied widely in discordance with current guideline recommendations. Optimal duration of anticoagulation therapy should be defined according to the risk of recurrent VTE and bleeding as well as death.

Keywords: Anticoagulants; Bleeding; Mortality; Recurrence; Venous thromboembolism.

Publication types

  • Clinical Trial
  • Multicenter Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anticoagulants / administration & dosage*
  • Anticoagulants / adverse effects
  • Female
  • Follow-Up Studies
  • Hemorrhage / chemically induced
  • Hemorrhage / nursing
  • Hemorrhage / therapy
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Neoplasms / drug therapy
  • Neoplasms / mortality
  • Registries*
  • Risk Factors
  • Thrombolytic Therapy*
  • Time Factors
  • Venous Thromboembolism / drug therapy*
  • Venous Thromboembolism / mortality

Substances

  • Anticoagulants