Journal Article

Risk factors of thrombotic recurrence and major bleeding in patients with intermediate-risk for recurrence of venous thromboembolism

Tsuyuki Yoshiaki, Hiramori Seiichi, Yamashita Yugo, Toyofuku Mamoru, Sasa Tomoki, Takabayashi Kensuke, Po-Min, Chen, Hata Reo, Kato Takao, Kobayashi Yohei, Takase Toru, Mabuchi, Hiroshi, Nishimoto Yuji, Matsushita Kazuki, Kinoshita Minako, Sano Arata, Kim, Kitae, Sakamoto Jiro, Kadota Kazushige, Akao Masaharu, Maki, Oi, Togi Kiyonori, Tada Tomohisa, Morimoto Takeshi, Kimura Takeshi, Amano Hidewo, Inoko Moriaki, Ono Koh, Murata Koichiro, Osakada Kohei

2022

Overview

Prolonged anticoagulation therapy is recommended for patients with intermediate-risk for recurrence of venous thromboembolism (VTE). The current study aimed to identify risk factors of VTE recurrence and major bleeding in intermediate-risk patients. The COMMAND VTE Registry is a multicenter registry enrolled consecutive 3027 patients with acute symptomatic VTE among 29 centers in Japan. The current study population consisted of 1703 patients with intermediate-risk for recurrence. The primary outcome measure was recurrent VTE during the entire follow-up period, and the secondary outcome measures were recurrent VTE and major bleeding during anticoagulation therapy. In the multivariable Cox regression model for recurrent VTE incorporating the status of anticoagulation therapy as a time-updated covariate, off-anticoagulation therapy was strongly associated with an increased risk for recurrent VTE (HR 9.42, 95% CI 5.97–14.86). During anticoagulation therapy, the independent risk factor for recurrent VTE was thrombophilia (HR 3.58, 95% CI 1.56–7.50), while the independent risk factors for major bleeding were age ≥ 75 years (HR 2.04, 95% CI 1.36–3.07), men (HR 1.52, 95% CI 1.02–2.27), history of major bleeding (HR 3.48, 95% CI 1.82–6.14) and thrombocytopenia (HR 3.73, 95% CI 2.04–6.37). Among VTE patients with intermediate-risk for recurrence, discontinuation of anticoagulation therapy was a very strong independent risk factor of recurrence during the entire follow-up period. The independent risk factors of recurrent VTE and those of major bleeding during anticoagulation therapy were different: thrombophilia for recurrent VTE, and advanced age, men, history of major bleeding, and thrombocytopenia for major bleeding.Clinical Trial RegistrationUnique identifier: UMIN000021132. COMMAND VTE Registry: http://www.umin.ac.jp/ctr/index.htm.

• Publisher: Springer Nature B.V
• Subject: Bleeding / Patients / Population studies / Risk factors / Thrombocytopenia / Thromboembolism / Thrombophilia