Real-world management and outcomes of venous thromboembolism in patients with cancer and limited life expectancy in the direct oral anticoagulant era: insights from the COMMAND VTE Registry-2

Optimal management strategies for venous thromboembolism (VTE) in patients with cancer and limited life expectancy (LLE) could still be challenging in the current era of widespread use of direct oral anticoagulants (DOACs). Real-world treatment patterns and outcomes in patients with LLE were investigated using a nationwide registry in Japan. The COMMAND VTE Registry-2 is a multicenter registry that enrolled 5,197 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 cancer patients with and without LLE. The main outcomes were the one-year cumulative incidences of VTE recurrence, major bleeding, and all-cause death. Incidences of VTE recurrence and major bleeding were estimated using a competing risk analysis, with death as the competing event. The study population consisted of 222 cancer patients with LLE (14.7%) and 1,285 patients without LLE (85.3%). Patients with LLE were older (mean age 69.9 vs. 67.8 years, P = 0.03) and received oral anticoagulants less frequently (80.6% vs. 92.1%, P < 0.001) than patients without LLE. Accounting for the competing risk of death, the one-year cumulative incidence of major bleeding was not significantly different between the two groups (11.0% vs. 10.5%, Gray’s test P = 0.91), whereas the incidence of VTE recurrence showed a trend to be lower in the LLE group (2.9% vs. 4.3%; P = 0.059). The cumulative one-year incidence of all-cause death was higher in the LLE group (94.1% vs. 35.4%, P < 0.001). Cancer patients with LLE were less likely to receive oral anticoagulants. Patients with LLE had a significantly higher one-year mortality rate than those without LLE. Accounting for the competing risk of death, there were no significant differences in the cumulative incidence of VTE recurrence or major bleeding between the two groups.

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Journal
Cardio-Oncology
Published
2025-12-22
DOI
https://doi.org/10.1186/s40959-025-00431-5
Primary Topic
Venous Thromboembolism Diagnosis and Management
Type
article
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article

Real-world management and outcomes of venous thromboembolism in patients with cancer and limited life expectancy in the direct oral anticoagulant era: insights from the COMMAND VTE Registry-2

Kensuke Takabayashi, Kazunori Otsui, K K Kim, Wataru Shioyama et al.
Cardio-Oncology
Venous Thromboembolism Diagnosis and Management
article

Real-world management and outcomes of venous thromboembolism in patients with cancer and limited life expectancy in the direct oral anticoagulant era: insights from the COMMAND VTE Registry-2

Kensuke Takabayashi, Kazunori Otsui, K K Kim, Wataru Shioyama, Takahiro Kuno, Ryuki Chatani, Norimichi Koitabashi, Seiichi Hiramori, Jiro Sakamoto, Daisuke Sueta, P Chen, Toru Takase, Kazuhisa Kaneda, Yoshiaki Ohyama, Moriaki Inoko, Nobutaka Ikeda, Takeshi Morimoto, Yugo Yamashita, Yoshiaki Tsuyuki, Koichiro Murata, Kosuke Doi, Hideki Ishii, Yuji Nishimoto, the COMMAND VTE Registry-2 Investigators, Takeshi Kimura, Yohei Kobayashi, Yoshito Ogihara, Hisato Nakai, Masaru Obokata, Maki Oi, Tomohiro Dohke, Kiyonori Togi, Noriaki Takama, Takeshi Inoue, Hiroshi Mabuchi, Takuma Takada, Shuhei Tsuji, Ryusuke Nishikawa, Shunsuke Usami, Satoshi Ikeda
article en

Abstract

Optimal management strategies for venous thromboembolism (VTE) in patients with cancer and limited life expectancy (LLE) could still be challenging in the current era of widespread use of direct oral anticoagulants (DOACs). Real-world treatment patterns and outcomes in patients with LLE were investigated using a nationwide registry in Japan. The COMMAND VTE Registry-2 is a multicenter registry that enrolled 5,197 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 cancer patients with and without LLE. The main outcomes were the one-year cumulative incidences of VTE recurrence, major bleeding, and all-cause death. Incidences of VTE recurrence and major bleeding were estimated using a competing risk analysis, with death as the competing event. The study population consisted of 222 cancer patients with LLE (14.7%) and 1,285 patients without LLE (85.3%). Patients with LLE were older (mean age 69.9 vs. 67.8 years, P = 0.03) and received oral anticoagulants less frequently (80.6% vs. 92.1%, P < 0.001) than patients without LLE. Accounting for the competing risk of death, the one-year cumulative incidence of major bleeding was not significantly different between the two groups (11.0% vs. 10.5%, Gray’s test P = 0.91), whereas the incidence of VTE recurrence showed a trend to be lower in the LLE group (2.9% vs. 4.3%; P = 0.059). The cumulative one-year incidence of all-cause death was higher in the LLE group (94.1% vs. 35.4%, P < 0.001). Cancer patients with LLE were less likely to receive oral anticoagulants. Patients with LLE had a significantly higher one-year mortality rate than those without LLE. Accounting for the competing risk of death, there were no significant differences in the cumulative incidence of VTE recurrence or major bleeding between the two groups.

Cardio-OncologyVol. 11(1)
Toho University (JP), Hyogo Medical University (JP), Shiga University of Medical Science (JP), Gunma University (JP), Mie University (JP), Kyoto University (JP), Tenri Hospital (JP), Kyoto Medical Center (JP), Taoka Hospital (JP), Osaka Kaisei Hospital (JP), Kurashiki Central Hospital (JP), Kobe University Hospital (JP), Toho University Ohashi Medical Center (JP), Kindai University Hospital (JP), Kansai Electric Power Hospital (JP), Shimada Municipal Hospital (JP), Gunma Prefectural Cardiovascular Center (JP), Shizuoka City Hospital (JP), Otsu Red Cross Hospital (JP), Hyogo Prefectural Amagasaki General Medical Center (JP), Tokyo Women's Medical University (JP), Koto Hospital (JP), Osaka Red Cross Hospital (JP), Japanese Red Cross Society Wakayama Medical Center (JP), Shiga Medical Center (JP), Kitano Hospital (JP), Kokura Memorial Hospital (JP), Kobe City Medical Center General Hospital (JP), Gunma University Hospital (JP), Municipal Hirakata City Hospital (JP), Nagasaki University (JP), Kindai University (JP), Kumamoto University (JP)
Forskningsrådet om Hälsa, Arbetsliv och Välfärd
Good health and well-being
Openalex Percentile: Top 28%
Venous Thromboembolism Diagnosis and Management
DOIOpen Access PDFOpenAlex
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