Hata Reo, Yamashita Yugo, Morimoto Takeshi, Kadota Kazushige, Amano Hidewo, Murai Ryosuke, Osakada Kohei, Sano Arata, Takase Toru, Hiramori Seiichi, Kim Kitae, Oi Maki, Akao Masaharu, Doi Kosuke, Kobayashi Yohei, Toyofuku Mamoru, Izumi Toshiaki, Tada Tomohisa, Chen Po-Min, Murata Koichiro, Tsuyuki Yoshiaki, Saga Syunsuke, Nishimoto Yuji, Sasa Tomoki, Sakamoto Jiro, Kinoshita Minako, Togi Kiyonori, Mabuchi Hiroshi, Takabayashi Kensuke, Tsujisaka Yuta, Seko Yuta, Matsushita Kazuki, Yoneda Fumiya, Kato Takao, Ono Koh, Kimura Takeshi
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan.
J Thromb Thrombolysis. 2022 Feb;53(2):540-549. doi: 10.1007/s11239-021-02564-7. Epub 2021 Sep 15.
Anticoagulation therapy is prescribed for the prevention of recurrence in patients with venous thromboembolism, which could be temporarily interrupted during invasive procedures. The COMMAND VTE Registry is a multicenter registry enrolling 3027 consecutive patients with acute symptomatic VTE in Japan between January 2010 and August 2014. We identified patients who underwent invasive procedures during the entire follow-up period and evaluated periprocedural managements and clinical outcomes at 30 days after invasive procedures. During a median follow-up period of 1213 (IQR: 847-1764) days, 518 patients underwent invasive procedures with the cumulative incidences of 5.8% at 3 months, 11.1% at 1 year, and 24.0% at 5 years. Among 382 patients in high bleeding-risk category of invasive procedures, anticoagulation therapy had been discontinued already in 62 patients (16%) and interrupted temporarily in 288 patients (75%) during the invasive procedures with bridging anticoagulation therapy with heparin in 214 patients (56%). Among 80 patients in low bleeding-risk category, anticoagulation therapy had been already discontinued in 15 patients (19%) and interrupted temporarily in 31 patients (39%) during invasive procedure with bridging anticoagulation therapy with heparin in 17 patients (21%). At 30 days after the invasive procedures, 14 patients (2.7%) experienced recurrent VTE, while 28 patients (5.4%) had major bleeding. This study elucidated the real-world features of peri-procedural management and prognosis in patients with VTE who underwent invasive procedures during follow-up in the large multicenter VTE registry. The 30-day incidence rates of recurrent VTE and major bleeding events were 2.7% and 5.4%.
抗凝治疗用于预防静脉血栓栓塞患者的复发，在侵入性操作期间可能会暂时中断。COMMAND VTE注册研究是一项多中心注册研究，在2010年1月至2014年8月期间连续纳入了日本3027例急性症状性VTE患者。我们确定了在整个随访期间接受侵入性操作的患者，并评估了侵入性操作后30天的围手术期管理和临床结局。在中位随访期1213（四分位间距：847-1764）天内，518例患者接受了侵入性操作，3个月时累积发生率为5.8%，1年时为11.1%，5年时为24.0%。在382例侵入性操作出血风险高的患者中，62例（16%）在侵入性操作期间已停用抗凝治疗，288例（75%）暂时中断，214例（56%）采用肝素桥接抗凝治疗。在80例侵入性操作出血风险低的患者中，15例（19%）在侵入性操作期间已停用抗凝治疗，31例（39%）暂时中断，17例（21%）采用肝素桥接抗凝治疗。侵入性操作后30天，14例（2.7%）发生复发性VTE，28例（5.4%）发生大出血。本研究阐明了在大型多中心VTE注册研究中随访期间接受侵入性操作的VTE患者围手术期管理和预后的真实世界特征。复发性VTE和大出血事件的30天发生率分别为2.7%和5.4%。
