Article ; Online: Optimal quality of vitamin K antagonist therapy in Japanese patients with venous thromboembolism.
2022 Volume 80, Issue 5, Page(s) 487–494
Abstract: Background: Vitamin K antagonist (VKA) remains an essential option for venous thromboembolism (VTE ...
Abstract | Background: Vitamin K antagonist (VKA) remains an essential option for venous thromboembolism (VTE), although direct oral anticoagulants have become available. However, there is a paucity of data on the optimal intensity and quality of control for VKA in Japanese. Methods: The COMMAND VTE Registry is a multicenter registry enrolling consecutive 3027 patients with acute symptomatic VTE among 29 centers in Japan. The current study population consisted of 1938 patients who received VKA with prothrombin time-international normalized ratio (PT-INR) measurement >5 times. The primary outcome measure was a composite of symptomatic VTE recurrence or major bleeding at 1 year. The presumed optimal quality of VKA therapy was defined as the combination of PT-INR range and time in therapeutic range (TTR) with the numerically lowest event rate. Results: The group with TTR ≥70 % based on PT-INR range ≥1.5 and <2.0 showed the lowest cumulative incidence rate. The cumulative 1-year incidence and the adjusted risk for the primary outcome measure were significantly lower in the optimal quality group than in the non-optimal quality group (5.2 % vs. 11.7 %, p = 0.001, and HR 0.49, 95%CI 0.28-0.81). Similarly, the cumulative 1-year incidences of a recurrent VTE, major bleeding, and all-cause death were significantly lower in the optimal quality group (recurrent VTE: 2.5 % vs. 6.0 %, p = 0.02; major bleeding: 2.8 % vs. 7.0 %, p = 0.008; and all-cause death: 2.8 % vs. 12.6 %, p < 0.0001). The lower risk of the optimal quality group relative to non-optimal quality group for the clinical outcomes was consistent regardless of the etiology of VTE (active cancer, transient risk factor, and unprovoked). Conclusions: The current VTE registry showed the optimal intensity of VKA therapy was target PT-INR range ≥1.5 and <2.0, which could support the current Japanese guideline recommendation, and the good quality of control for VKA therapy of TTR ≥70 % was independently associated with better outcomes. |
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MeSH term(s) | Anticoagulants/adverse effects ; Fibrinolytic Agents/therapeutic use ; Hemorrhage/chemically induced ; Hemorrhage/epidemiology ; Humans ; Japan/epidemiology ; Recurrence ; Venous Thromboembolism/drug therapy ; Vitamin K |
Chemical Substances | Anticoagulants ; Fibrinolytic Agents ; Vitamin K (12001-79-5) |
Language | English |
Publishing date | 2022-07-23 |
Publishing country | Netherlands |
Document type | Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't |
ZDB-ID | 639364-0 |
ISSN | 1876-4738 ; 0386-2887 ; 0914-5087 |
ISSN (online) | 1876-4738 |
ISSN | 0386-2887 ; 0914-5087 |
DOI | 10.1016/j.jjcc.2022.07.001 |
Database | MEDical Literature Analysis and Retrieval System OnLINE |
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