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Background <p>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.</p> Methods <p>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.</p> Results <p>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&#xa0;years, <i>P</i> = 0.03) and received oral anticoagulants less frequently (80.6% vs. 92.1%, <i>P</i> &lt; 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 <i>P</i> = 0.91), whereas the incidence of VTE recurrence showed a trend to be lower in the LLE group (2.9% vs. 4.3%; <i>P</i> = 0.059). The cumulative one-year incidence of all-cause death was higher in the LLE group (94.1% vs. 35.4%, <i>P</i> &lt; 0.001).</p> Conclusion <p>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.</p>

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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

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  • 发表日期：

    2025年12月22日

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

摘要

Background

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.

Methods

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.

Results

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).

Conclusion

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.