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Thromb Haemost
DOI: 10.1055/a-2316-5269
Stroke, Systemic or Venous Thromboembolism

Edoxaban, Rivaroxaban, or Apixaban for Cancer-Associated Venous Thromboembolism in the Real World: Insights from the COMMAND VTE Registry-2

Daisuke Sueta 
1   Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
,
Yugo Yamashita
2   Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
,
Takeshi Morimoto
3   Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan
,
Ryuki Chatani
4   Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
,
Yuji Nishimoto
5   Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
,
Kazuhisa Kaneda
2   Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
,
Nobutaka Ikeda
6   Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
,
Yohei Kobayashi
7   Department of Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
,
Satoshi Ikeda
8   Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
,
Kitae Kim
9   Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
,
Moriaki Inoko
10   Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
,
Toru Takase
11   Department of Cardiology, Kinki University Hospital, Osaka, Japan
,
Shuhei Tsuji
12   Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
,
Maki Oi
13   Department of Cardiology, Japanese Red Cross Otsu Hospital, Otsu, Japan
,
Takuma Takada
14   Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
,
Kazunori Otsui
15   Department of General Internal Medicine, Kobe University Hospital, Kobe, Japan
,
Jiro Sakamoto
16   Department of Cardiology, Tenri Hospital, Tenri, Japan
,
Yoshito Ogihara
17   Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
,
Takeshi Inoue
18   Department of Cardiology, Shiga General Hospital, Moriyama, Japan
,
Shunsuke Usami
19   Department of Cardiology, Kansai Electric Power Hospital, Osaka, Japan
,
Po-Min Chen
20   Department of Cardiology, Osaka Saiseikai Noe Hospital, Osaka, Japan
,
Kiyonori Togi
21   Division of Cardiology, Nara Hospital, Kinki University Faculty of Medicine, Ikoma, Japan
,
Norimichi Koitabashi
22   Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
,
Seiichi Hiramori
23   Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
,
Kosuke Doi
24   Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
,
Hiroshi Mabuchi
25   Department of Cardiology, Koto Memorial Hospital, Higashiomi, Japan
,
Yoshiaki Tsuyuki
26   Division of Cardiology, Shimada General Medical Center, Shimada, Japan
,
Koichiro Murata
27   Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
,
Kensuke Takabayashi
28   Department of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan
,
Hisato Nakai
29   Department of Cardiovascular Medicine, Sugita Genpaku Memorial Obama Municipal Hospital, Obama, Japan
,
Wataru Shioyama
30   Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan
,
Tomohiro Dohke
31   Division of Cardiology, Kohka Public Hospital, Koka, Japan
,
Ryusuke Nishikawa
2   Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
,
Takeshi Kimura
28   Department of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan
,
Kenichi Tsujita
1   Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
,
On behalf of the COMMAND VTE Registry-2 Investigators › Author Affiliations Funding This study was supported in part by Grants-in-Aid for Scientific Research (#20K17087) from the Ministry of Education, Culture, Sports, Science and Technology of Japan.
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Abstract

Background Real-world data on clinical characteristics and outcomes related to the use of different direct oral anticoagulants (DOACs) for cancer-associated venous thromboembolism (VTE) is lacking.

Methods The COMMAND VTE Registry-2 is a multicenter registry enrolling 5,197 consecutive patients with acute symptomatic VTE from 31 centers in Japan from January 2015 to August 2020. Our study population comprised 1,197 patients with active cancer who were divided into the edoxaban (N = 643, 54%), rivaroxaban (N = 297, 25%), and apixaban (N = 257, 22%) groups.

Results The cumulative 5-year incidence of recurrent VTE (9.3, 10.2, and 8.5%, respectively, p = 0.82) and all-cause death (67.5, 66.8, and 63.8%, respectively, p = 0.22) did not differ among the groups. Despite adjusting for confounders, the risks of recurrent VTE and all-cause death did not differ significantly among the groups. The cumulative 5-year incidence of major and clinically relevant bleeding was significantly lower in the rivaroxaban group than those in the other groups (22.6, 14.0, and 22.8%, p = 0.04; and 37.6, 26.8, and 38.3%, p = 0.01, respectively). After adjusting for confounders, in the rivaroxaban group, the risk for major bleeding was numerically lower (hazard ratio [HR]: 0.65, 95% confidence interval [CI]: 0.40–1.01) and that of clinically relevant all bleeding was significantly lower (HR: 0.67, 95% CI: 0.48–0.92) than those in the edoxaban group.

Conclusion The risks of recurrent VTE and all-cause death did not differ significantly among the different DOACs ; however, the risk of bleeding events could differ, with a potentially lower risk of bleeding with rivaroxaban.

Keywords

venous thromboembolism - cancer-associated VTE - DOACs

Authors' Contribution

D.S.: writing—original draft, investigation, funding acquisition, conceptualization. Y.Y.: writing—review and editing, project administration, conceptualization. T.M.: formal analysis. R.C., Y.N., K.K., N.I., Y.K., S.I., K.K., M.I., T.T., S.T., M.O., T.T., K.O., J.S., Y.O., T.I., S.U., P.-M.C., K.T., N.K., S.H., K.D., H.M., Y.T., K.M., K.T., H.N., W.S., T.D., R.N.: investigation. Takeshi Kimura: writing—review and editing, supervision, project administration, conceptualization. K.T.: supervision.


Supplementary Material



Publication History

Received: 28 March 2024

Accepted: 28 April 2024

Accepted Manuscript online:
29 April 2024

Article published online:
24 May 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
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