Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University.
Department of Clinical Epidemiology, Hyogo College of Medicine.
Circ J. 2018 Apr 25;82(5):1262-1270. doi: 10.1253/circj.CJ-17-1128. Epub 2018 Mar 23.
Venous thromboembolism (VTE) has a long-term risk of recurrence, which can be prevented by anticoagulation therapy.
The COMMAND VTE Registry is a multicenter registry enrolling 3,027 consecutive patients with acute symptomatic VTE between January 2010 and August 2014. The entire cohort was divided into the transient risk (n=855, 28%), unprovoked (n=1,477, 49%), and cancer groups (n=695, 23%). The rate of anticoagulation discontinuation was highest in the cancer group (transient risk: 37.3% vs. unprovoked: 21.4% vs. cancer: 43.5% at 1 year, P<0.001). The cumulative 5-year incidences of recurrent VTE, major bleeding and all-cause death were highest in the cancer group (recurrent VTE: 7.9% vs. 9.3% vs. 17.7%, P<0.001; major bleeding: 9.0% vs. 9.4% vs. 26.6%, P<0.001; and all-cause death: 17.4% vs. 15.3% vs. 73.1%, P<0.001). After discontinuation of anticoagulation therapy, the cumulative 3-year incidence of recurrent VTE was lowest in the transient risk group (transient risk: 6.1% vs. unprovoked: 15.3% vs. cancer: 13.2%, P=0.001). The cumulative 3-year incidence of recurrent VTE beyond 1 year was lower in patients on anticoagulation than in patients off anticoagulation at 1 year in the unprovoked group (on: 3.7% vs. off: 12.2%, P<0.001), but not in the transient risk and cancer groups (respectively, 1.6% vs. 2.5%, P=0.30; 5.6% vs. 8.6%, P=0.44).
The duration of anticoagulation therapy varied widely in discordance with current guideline recommendations. Optimal duration of anticoagulation therapy should be defined according to the risk of recurrent VTE and bleeding as well as death.
静脉血栓栓塞症（VTE）有长期复发的风险，可通过抗凝治疗预防。
COMMAND VTE 注册研究是一项多中心注册研究，纳入了 2010 年 1 月至 2014 年 8 月期间 3027 例急性有症状 VTE 连续患者。整个队列分为一过性风险（n=855，28%）、无诱因（n=1477，49%）和癌症组（n=695，23%）。癌症组的抗凝治疗停药率最高（一过性风险：1 年时为 37.3% vs. 无诱因：21.4% vs. 癌症：43.5%，P<0.001）。癌症组的 5 年累积复发 VTE、大出血和全因死亡率最高（复发 VTE：7.9% vs. 9.3% vs. 17.7%，P<0.001；大出血：9.0% vs. 9.4% vs. 26.6%，P<0.001；全因死亡：17.4% vs. 15.3% vs. 73.1%，P<0.001）。停止抗凝治疗后，一过性风险组的 3 年累积复发 VTE 发生率最低（一过性风险：6.1% vs. 无诱因：15.3% vs. 癌症：13.2%，P=0.001）。无诱因组中，1 年时接受抗凝治疗的患者 3 年累积复发 VTE 的发生率低于未接受抗凝治疗的患者（接受治疗：3.7% vs. 未接受治疗：12.2%，P<0.001），但在一过性风险和癌症组中并非如此（分别为 1.6% vs. 2.5%，P=0.30；5.6% vs. 8.6%，P=0.44）。
抗凝治疗的持续时间与当前指南推荐不一致，差异很大。应根据复发 VTE 和出血以及死亡的风险来确定抗凝治疗的最佳持续时间。
