Effectiveness and Safety of Direct Oral Anticoagulants vs. Warfarin and Recurrence After Discontinuation in Patients With Acute Venous Thromboembolism in the Real World
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 patie...
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| Veröffentlicht in: | Circulation Journal 2022/05/25, Vol.86(6), pp.923-933 |
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| creator | Hara, Nobuhiro Lee, Tetsumin Nozato, Toshihiro Matsuyama, Mao Terui 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 |
| description | 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 |
| doi_str_mv | 10.1253/circj.CJ-21-0588 |
| format | Article |
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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.</description><identifier>ISSN: 1346-9843</identifier><identifier>ISSN: 1347-4820</identifier><identifier>EISSN: 1347-4820</identifier><identifier>DOI: 10.1253/circj.CJ-21-0588</identifier><identifier>PMID: 34645732</identifier><language>eng</language><publisher>Japan: The Japanese Circulation Society</publisher><subject>Administration, Oral ; Anticoagulants ; Anticoagulants - therapeutic use ; Hemorrhage - chemically induced ; Humans ; Pulmonary embolism ; Recurrence ; Retrospective Studies ; Venous thromboembolism ; Venous Thromboembolism - drug therapy ; Venous Thromboembolism - epidemiology ; Venous Thrombosis - drug therapy ; Warfarin - therapeutic use</subject><ispartof>Circulation Journal, 2022/05/25, Vol.86(6), pp.923-933</ispartof><rights>2022, THE JAPANESE CIRCULATION SOCIETY</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c470t-7748706c9963a858c31bc78b058f9f7841b92c4b0d2a2b75a3df12d4f176846e3</citedby><cites>FETCH-LOGICAL-c470t-7748706c9963a858c31bc78b058f9f7841b92c4b0d2a2b75a3df12d4f176846e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,1883,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34645732$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hara, Nobuhiro</creatorcontrib><creatorcontrib>Lee, Tetsumin</creatorcontrib><creatorcontrib>Nozato, Toshihiro</creatorcontrib><creatorcontrib>Matsuyama, Mao Terui</creatorcontrib><creatorcontrib>Okata, Shinichiro</creatorcontrib><creatorcontrib>Nagase, Masashi</creatorcontrib><creatorcontrib>Mitsui, Kentaro</creatorcontrib><creatorcontrib>Nitta, Giichi</creatorcontrib><creatorcontrib>Watanabe, Keita</creatorcontrib><creatorcontrib>Miyazaki, Ryoichi</creatorcontrib><creatorcontrib>Nagamine, Sho</creatorcontrib><creatorcontrib>Kaneko, Masakazu</creatorcontrib><creatorcontrib>Nakamura, Tomofumi</creatorcontrib><creatorcontrib>Nagata, Yasutoshi</creatorcontrib><creatorcontrib>Miyamoto, Takamichi</creatorcontrib><creatorcontrib>Obayashi, Toru</creatorcontrib><creatorcontrib>Ashikaga, Takashi</creatorcontrib><title>Effectiveness and Safety of Direct Oral Anticoagulants vs. Warfarin and Recurrence After Discontinuation in Patients With Acute Venous Thromboembolism in the Real World</title><title>Circulation Journal</title><addtitle>Circ J</addtitle><description>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.</description><subject>Administration, Oral</subject><subject>Anticoagulants</subject><subject>Anticoagulants - therapeutic use</subject><subject>Hemorrhage - chemically induced</subject><subject>Humans</subject><subject>Pulmonary embolism</subject><subject>Recurrence</subject><subject>Retrospective Studies</subject><subject>Venous thromboembolism</subject><subject>Venous Thromboembolism - drug therapy</subject><subject>Venous Thromboembolism - epidemiology</subject><subject>Venous Thrombosis - drug therapy</subject><subject>Warfarin - therapeutic use</subject><issn>1346-9843</issn><issn>1347-4820</issn><issn>1347-4820</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkUtv3CAUha2qUfNo911VLLvxlJcNXo6mSZMoUqI27SwRxpeMRzakgCPlH_VnBs9MkwVwBd85cDlF8ZngBaEV-2b6YLaL1XVJSYkrKd8VJ4RxUXJJ8ftdXZeN5Oy4OI1xizFtcNV8KI7zPq8EoyfFv3NrwaT-CRzEiLTr0C9tIT0jb9H3PuQzdBv0gJYu9cbrh2nQLkX0FBdorYPVoXc71U8wUwjgDKClTRCyOBqfRW7SqfcOZe4uVzCr133aoKWZEqA_4PwU0f0m-LH1kMfQx3Gm0waya7567cPQfSyOrB4ifDqsZ8Xvi_P71WV5c_vjarW8KQ0XOJVCcClwbZqmZlpW0jDSGiHb_Du2sUJy0jbU8BZ3VNNWVJp1ltCOWyJqyWtgZ8XXve9j8H8niEmNuREYctuQH6poJSnBUjCSUbxHTfAxBrDqMfSjDs-KYDXno3b5qNW1okTN-WTJl4P71I7QvQr-B5KBiz2wjUk_wCugQ_7-AQ6Oslb1PL05vwEbHRQ49gIkH6iI</recordid><startdate>20220525</startdate><enddate>20220525</enddate><creator>Hara, Nobuhiro</creator><creator>Lee, Tetsumin</creator><creator>Nozato, Toshihiro</creator><creator>Matsuyama, Mao Terui</creator><creator>Okata, Shinichiro</creator><creator>Nagase, Masashi</creator><creator>Mitsui, Kentaro</creator><creator>Nitta, Giichi</creator><creator>Watanabe, Keita</creator><creator>Miyazaki, Ryoichi</creator><creator>Nagamine, Sho</creator><creator>Kaneko, Masakazu</creator><creator>Nakamura, Tomofumi</creator><creator>Nagata, Yasutoshi</creator><creator>Miyamoto, Takamichi</creator><creator>Obayashi, Toru</creator><creator>Ashikaga, Takashi</creator><general>The Japanese Circulation Society</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20220525</creationdate><title>Effectiveness and Safety of Direct Oral Anticoagulants vs. Warfarin and Recurrence After Discontinuation in Patients With Acute Venous Thromboembolism in the Real World</title><author>Hara, Nobuhiro ; Lee, Tetsumin ; Nozato, Toshihiro ; Matsuyama, Mao Terui ; 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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c470t-7748706c9963a858c31bc78b058f9f7841b92c4b0d2a2b75a3df12d4f176846e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Administration, Oral</topic><topic>Anticoagulants</topic><topic>Anticoagulants - therapeutic use</topic><topic>Hemorrhage - chemically induced</topic><topic>Humans</topic><topic>Pulmonary embolism</topic><topic>Recurrence</topic><topic>Retrospective Studies</topic><topic>Venous thromboembolism</topic><topic>Venous Thromboembolism - drug therapy</topic><topic>Venous Thromboembolism - epidemiology</topic><topic>Venous Thrombosis - drug therapy</topic><topic>Warfarin - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hara, Nobuhiro</creatorcontrib><creatorcontrib>Lee, Tetsumin</creatorcontrib><creatorcontrib>Nozato, Toshihiro</creatorcontrib><creatorcontrib>Matsuyama, Mao Terui</creatorcontrib><creatorcontrib>Okata, Shinichiro</creatorcontrib><creatorcontrib>Nagase, Masashi</creatorcontrib><creatorcontrib>Mitsui, Kentaro</creatorcontrib><creatorcontrib>Nitta, Giichi</creatorcontrib><creatorcontrib>Watanabe, Keita</creatorcontrib><creatorcontrib>Miyazaki, Ryoichi</creatorcontrib><creatorcontrib>Nagamine, Sho</creatorcontrib><creatorcontrib>Kaneko, Masakazu</creatorcontrib><creatorcontrib>Nakamura, Tomofumi</creatorcontrib><creatorcontrib>Nagata, Yasutoshi</creatorcontrib><creatorcontrib>Miyamoto, Takamichi</creatorcontrib><creatorcontrib>Obayashi, Toru</creatorcontrib><creatorcontrib>Ashikaga, Takashi</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation Journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hara, Nobuhiro</au><au>Lee, Tetsumin</au><au>Nozato, Toshihiro</au><au>Matsuyama, Mao Terui</au><au>Okata, Shinichiro</au><au>Nagase, Masashi</au><au>Mitsui, Kentaro</au><au>Nitta, Giichi</au><au>Watanabe, Keita</au><au>Miyazaki, Ryoichi</au><au>Nagamine, Sho</au><au>Kaneko, Masakazu</au><au>Nakamura, Tomofumi</au><au>Nagata, Yasutoshi</au><au>Miyamoto, Takamichi</au><au>Obayashi, Toru</au><au>Ashikaga, Takashi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effectiveness and Safety of Direct Oral Anticoagulants vs. Warfarin and Recurrence After Discontinuation in Patients With Acute Venous Thromboembolism in the Real World</atitle><jtitle>Circulation Journal</jtitle><addtitle>Circ J</addtitle><date>2022-05-25</date><risdate>2022</risdate><volume>86</volume><issue>6</issue><spage>923</spage><epage>933</epage><pages>923-933</pages><artnum>CJ-21-0588</artnum><issn>1346-9843</issn><issn>1347-4820</issn><eissn>1347-4820</eissn><abstract>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.</abstract><cop>Japan</cop><pub>The Japanese Circulation Society</pub><pmid>34645732</pmid><doi>10.1253/circj.CJ-21-0588</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Administration, Oral Anticoagulants Anticoagulants - therapeutic use Hemorrhage - chemically induced Humans Pulmonary embolism Recurrence Retrospective Studies Venous thromboembolism Venous Thromboembolism - drug therapy Venous Thromboembolism - epidemiology Venous Thrombosis - drug therapy Warfarin - therapeutic use |
| title | Effectiveness and Safety of Direct Oral Anticoagulants vs. Warfarin and Recurrence After Discontinuation in Patients With Acute Venous Thromboembolism in the Real World |
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