Abstract
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%.
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References
Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H et al (2016) Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest 149:315–352
Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP et al (2020) 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J 4:543–603
James D Douketis, Alex C Spyropoulos, Scott Kaatz, Richard C Becker, Joseph A Caprini, Andrew S Dunn, David A Garcia et al (2015) Perioperative bridging anticoagulation in patients with atrial fibrillation. N Engl J Med 373:823–833.
John U Doherty, Ty J Gluckman, William J Hucker, James L Januzzi Jr, Thomas L Ortel, Sherry J et al (2017) 2017 ACC expert consensus decision pathway for periprocedural management of anticoagulation in patients with nonvalvular atrial fibrillation: a report of the American College of Cardiology Clinical Expert Consensus Document Task Force. J Am Coll Cardiol 69:871–898.
Douketis JD, Spyropoulos AC, Spencer FA, Mayr M, Jaffer AK, Eckman MH et al (2012) Perioperative management of antithrombotic therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141:e326S-e350S
Yamashita Y, Morimoto T, Amano H, Takase T, Hiramori S, Kim K et al (2018) Anticoagulation therapy for venous thromboembolism in the real world - from the COMMAND VTE registry. Circ J 82:1262–1270
Goldhaber SZ, Visani L, De Rosa M (1999) Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 353:1386–1389
James D Douketis, Alex C Spyropoulos, Scott Kaatz, Richard C Becker, Joseph A Caprini, Andrew S Dunn, et al (2015) Perioperative bridging anticoagulation in patients with atrial fibrillation. N Engl J Med 373:823–833.
Spyropoulos AC, Douketis JD, Gerotziafas G, Kaatz S, Ortel TL, Schulman S (2012) Periprocedural antithrombotic and bridging therapy: recommendations for standardized reporting in patients with arterial indications for chronic oral anticoagulant therapy. J Thromb Haemost 10:692–694
Harry R Büller, Hervé Décousus, Michael A Grosso, Michele Mercuri, Saskia Middeldorp, Martin H Prins, et al (2013) Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism. N Engl J Med 369:1406–1415.
Shaw J, de Wit C, Le Gal G, Carrier M (2017) Thrombotic and bleeding outcomes following perioperative interruption of direct oral anticoagulants in patients with venous thromboembolic disease. J Thromb Haemost 15:925–930
Schulman S, Kearon C (2005) Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost 3:692–694
Kristian Thygesen, Joseph S Alpert, Allan S Jaffe, Maarten L Simoons, Bernard R Chaitman, Harvey D White, et al (2012) Third universal definition of myocardial infarction. Circulation 126:2020–2035
Spyropoulos AC, Turpie AGG, Dunn AS, Spandorfer J, Douketis J, Jacobson A, Frost FJ (2006) Clinical outcomes with unfractionated heparin or low-molecular-weight heparin as bridging therapy in patients on long-term oral anticoagulants: the REGIMEN registry. J Thromb Haemost 4(6):1246–1252
Garcia DA, Regan S, Henault LE, Upadhyay A, Baker J, Othman M, Hylek EM (2008) Risk of thromboembolism with short-term interruption of warfarin therapy. Arch Intern Med 168:63–69.
Tafur AJ, McBane R 2nd, Wysokinski WE, Litin S, Daniels P, Slusser J, Hodge D, Beckman MG, Heit JA (2012) Predictors of major bleeding in peri-procedural anticoagulation management. J Thromb Haemost 10:261–267
Nathan P Clark, Daniel M Witt, Loren E Davies, Edward M Saito, Kathleen H McCool, James D Douketis et al (2015) Bleeding, recurrent venous thromboembolism, and mortality risks during warfarin interruption for invasive procedures. JAMA Intern Med 175:1163–1168.
Shaw JR, Douketis J, Le Gal G, Carrier M (2019) Periprocedural interruption of anticoagulation in patients with cancer-associated venous thromboembolism: an analysis of thrombotic and bleeding outcomes. J Thromb Haemost 17:1171–1178.
Burnett AE, Mahan CE, Vazquez SR, Oertel LB, Garcia DA, Ansell J (2016) Guidance for the practical management of the direct oral anticoagulants (DOACs) in VTE treatment. J Thromb Thrombolysis 41:206–232.
Schulman S, Carrier M, Lee AYY, Shivakumar S, Blostein M, Spencer FA, et al (2015) Perioperative management of dabigatran: a prospective cohort study. Circulation 132:167–173.
Acknowledgements
We appreciate the support and collaboration of the co-investigators participating in the COMMAND VTE Registry. We are indebted to the independent clinical research organization (Research Institute for Production Development, Kyoto, Japan) for technical support.
Funding
The COMMAND VTE Registry is supported by the independent clinical research organization (Research Institute for Production Development, Kyoto, Japan) and research funding from Mitsubishi Tanabe Pharma Corporation. The research funding had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.
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Dr. Yamashita received lecture fees from Daiichi-Sankyo, Pfizer, Bristol-Myers Squibb, and Bayer Healthcare. Dr. Morimoto received lecture fees from Mitsubishi Tanabe Pharma and Pfizer Japan and consultant fees from Asahi Kasei, Bristol-Myers Squibb, and Boston Scientific. Dr. Akao received lecture fees from Pfizer, Bristol-Myers Squibb, Boehringer Ingelheim, Bayer Healthcare and Daiichi-Sankyo. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
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This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Kyoto University Hospital Ethics Committee approved this study (the approval number R0493).
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Hata, R., Yamashita, Y., Morimoto, T. et al. Periprocedural management and clinical outcomes of invasive procedures after venous thromboembolism: from the COMMAND VTE registry. J Thromb Thrombolysis 53, 540–549 (2022). https://doi.org/10.1007/s11239-021-02564-7
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DOI: https://doi.org/10.1007/s11239-021-02564-7