Sex differences in clinical characteristics, management, and outcomes in patients with venous thromboembolism in the direct oral anticoagulant era: Insight from the COMMAND VTE Registry-2

Introduction: Sex-specific differences in the prognosis of venous thromboembolism (VTE) remain controversial, particularly in the current era of widespread use of direct oral anticoagulants. Real-world management and outcomes of VTE stratified by sex were investigated in a nationwide registry. Methods: The COMMAND VTE Registry-2 is a multicenter registry that enrolled 5197 consecutive acute symptomatic VTE patients from 31 centers in Japan between January 2015 and August 2020. In this cohort, baseline characteristics, anticoagulation strategies, and long-term clinical outcomes were compared between men and women. Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratios for clinical outcomes. Results: The study population consisted of 2134 men (41.1 %) and 3063 women (58.9 %). Compared with women, men were younger (mean age ± standard deviation, 66.1 ± 14.7 vs. 68.9 ± 16.2 years, P < 0.001), more frequently had active cancer (31.1 % vs. 27.6 %, P = 0.006), and were less likely to present with transient risk factors (32.4 % vs. 40.5 %, P < 0.001). Pulmonary embolism was more common in men (56.7 % vs. 51.5 %, P < 0.001). There were no significant differences in the cumulative 5-year incidences of recurrent VTE or major bleeding between men and women (7.3 % vs. 7.8 %, P = 0.77; 10.8 % vs. 12.4 %, P = 0.20). Although the incidence of all-cause death was higher in men (34.5 % vs. 30.6 %, P = 0.02), this difference was not significant after multivariable adjustment (hazard ratio 1.05, 95 % confidence interval 0.94–1.17, P = 0.39). Conclusion: In this large, multicenter registry, sex was not associated with recurrent thrombosis, major bleeding, or long-term mortality after multivariable adjustment.

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Publication Details

Journal
Thrombosis Update
Published
2025-11-21
DOI
https://doi.org/10.1016/j.tru.2025.100229
Primary Topic
Venous Thromboembolism Diagnosis and Management
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article
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article

Sex differences in clinical characteristics, management, and outcomes in patients with venous thromboembolism in the direct oral anticoagulant era: Insight from the COMMAND VTE Registry-2

Masaru Obokata, Satoshi Ikeda, Kiyonori Togi, Kazunori Otsui et al.
Thrombosis Update
Venous Thromboembolism Diagnosis and Management
article

Sex differences in clinical characteristics, management, and outcomes in patients with venous thromboembolism in the direct oral anticoagulant era: Insight from the COMMAND VTE Registry-2

Masaru Obokata, Satoshi Ikeda, Kiyonori Togi, Kazunori Otsui, Shunsuke Usami, Ryusuke Nishikawa, Hiroshi Mabuchi, Wataru Shioyama, Takahiro Kuno, Ryuki Chatani, Takeshi Inoue, Norimichi Koitabashi, Noriaki Takama, Kensuke Takabayashi, Seiichi Hiramori, Jiro Sakamoto, Daisuke Sueta, Yugo Yamashita, Takeshi Morimoto, Toru Takase, Kazuhisa Kaneda, Yoshiaki Ohyama, Moriaki Inoko, Yoshito Ogihara, Nobutaka Ikeda, Yuji Nishimoto, Takuma Takada, Yoshiaki Tsuyuki, Takeshi Kimura, Kitae Kim, Koichiro Murata, Maki Oi, S. Tsuji, Yohei Kobayashi, Po‐Min Chen, Hisato Nakai, Kosuke Doi, Tomohiro Dohke, Hideki Ishii
article en

Abstract

Introduction: Sex-specific differences in the prognosis of venous thromboembolism (VTE) remain controversial, particularly in the current era of widespread use of direct oral anticoagulants. Real-world management and outcomes of VTE stratified by sex were investigated in a nationwide registry. Methods: The COMMAND VTE Registry-2 is a multicenter registry that enrolled 5197 consecutive acute symptomatic VTE patients from 31 centers in Japan between January 2015 and August 2020. In this cohort, baseline characteristics, anticoagulation strategies, and long-term clinical outcomes were compared between men and women. Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratios for clinical outcomes. Results: The study population consisted of 2134 men (41.1 %) and 3063 women (58.9 %). Compared with women, men were younger (mean age ± standard deviation, 66.1 ± 14.7 vs. 68.9 ± 16.2 years, P < 0.001), more frequently had active cancer (31.1 % vs. 27.6 %, P = 0.006), and were less likely to present with transient risk factors (32.4 % vs. 40.5 %, P < 0.001). Pulmonary embolism was more common in men (56.7 % vs. 51.5 %, P < 0.001). There were no significant differences in the cumulative 5-year incidences of recurrent VTE or major bleeding between men and women (7.3 % vs. 7.8 %, P = 0.77; 10.8 % vs. 12.4 %, P = 0.20). Although the incidence of all-cause death was higher in men (34.5 % vs. 30.6 %, P = 0.02), this difference was not significant after multivariable adjustment (hazard ratio 1.05, 95 % confidence interval 0.94–1.17, P = 0.39). Conclusion: In this large, multicenter registry, sex was not associated with recurrent thrombosis, major bleeding, or long-term mortality after multivariable adjustment.

Thrombosis UpdateVol. 21
Openalex Percentile: Top 44%
Venous Thromboembolism Diagnosis and Management
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