Edoxaban, Rivaroxaban, or Apixaban for Cancer-Associated Venous Thromboembolism in the Real World: Insights from the COMMAND VTE Registry-2

Daisuke Sueta; Yugo Yamashita; Takeshi Morimoto; Ryuki Chatani; Yuji Nishimoto; Kazuhisa Kaneda; 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; Norimichi Koitabashi; Seiichi Hiramori; Kosuke Doi; Hiroshi Mabuchi; Yoshiaki Tsuyuki; Koichiro Murata; Kensuke Takabayashi; Hisato Nakai; Wataru Shioyama; Tomohiro Dohke; Ryusuke Nishikawa; Takeshi Kimura; Kenichi Tsujita; On behalf of the COMMAND VTE Registry-2 Investigators

doi:10.1055/a-2316-5269

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2024; 124(11): 1013-1023
DOI: 10.1055/a-2316-5269

Stroke, Systemic or Venous Thromboembolism

Edoxaban, Rivaroxaban, or Apixaban for Cancer-Associated Venous Thromboembolism in the Real World: Insights from the COMMAND VTE Registry-2

Daisuke Sueta

¹Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan

,

Yugo Yamashita

²Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan

,

Takeshi Morimoto

³Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan

,

Ryuki Chatani

⁴Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan

,

Yuji Nishimoto

⁵Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan

,

Kazuhisa Kaneda

²Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan

,

Nobutaka Ikeda

⁶Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan

,

Yohei Kobayashi

⁷Department of Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan

,

Satoshi Ikeda

⁸Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan

,

Kitae Kim

⁹Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan

,

Moriaki Inoko

¹⁰Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan

,

Toru Takase

¹¹Department of Cardiology, Kinki University Hospital, Osaka, Japan

,

Shuhei Tsuji

¹²Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan

,

Maki Oi

¹³Department of Cardiology, Japanese Red Cross Otsu Hospital, Otsu, Japan

,

Takuma Takada

¹⁴Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan

,

Kazunori Otsui

¹⁵Department of General Internal Medicine, Kobe University Hospital, Kobe, Japan

,

Jiro Sakamoto

¹⁶Department of Cardiology, Tenri Hospital, Tenri, Japan

,

Yoshito Ogihara

¹⁷Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan

,

Takeshi Inoue

¹⁸Department of Cardiology, Shiga General Hospital, Moriyama, Japan

,

Shunsuke Usami

¹⁹Department of Cardiology, Kansai Electric Power Hospital, Osaka, Japan

,

Po-Min Chen

²⁰Department of Cardiology, Osaka Saiseikai Noe Hospital, Osaka, Japan

,

Kiyonori Togi

²¹Division of Cardiology, Nara Hospital, Kinki University Faculty of Medicine, Ikoma, Japan

,

Norimichi Koitabashi

²²Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan

,

Seiichi Hiramori

²³Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan

,

Kosuke Doi

²⁴Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan

,

Hiroshi Mabuchi

²⁵Department of Cardiology, Koto Memorial Hospital, Higashiomi, Japan

,

Yoshiaki Tsuyuki

²⁶Division of Cardiology, Shimada General Medical Center, Shimada, Japan

,

Koichiro Murata

²⁷Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan

,

Kensuke Takabayashi

²⁸Department of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan

,

Hisato Nakai

²⁹Department of Cardiovascular Medicine, Sugita Genpaku Memorial Obama Municipal Hospital, Obama, Japan

,

Wataru Shioyama

³⁰Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan

,

Tomohiro Dohke

³¹Division of Cardiology, Kohka Public Hospital, Koka, Japan

,

Ryusuke Nishikawa

²Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan

,

Takeshi Kimura

²⁸Department of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan

,

Kenichi Tsujita

¹Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan

,

On behalf of the COMMAND VTE Registry-2 Investigators

› Author Affiliations

Abstract

Background Real-world data on clinical characteristics and outcomes related to the use of different direct oral anticoagulants (DOACs) for cancer-associated venous thromboembolism (VTE) is lacking.

Methods The COMMAND VTE Registry-2 is a multicenter registry enrolling 5,197 consecutive patients with acute symptomatic VTE from 31 centers in Japan from January 2015 to August 2020. Our study population comprised 1,197 patients with active cancer who were divided into the edoxaban (N = 643, 54%), rivaroxaban (N = 297, 25%), and apixaban (N = 257, 22%) groups.

Results The cumulative 5-year incidence of recurrent VTE (9.3, 10.2, and 8.5%, respectively, p = 0.82) and all-cause death (67.5, 66.8, and 63.8%, respectively, p = 0.22) did not differ among the groups. Despite adjusting for confounders, the risks of recurrent VTE and all-cause death did not differ significantly among the groups. The cumulative 5-year incidence of major and clinically relevant bleeding was significantly lower in the rivaroxaban group than those in the other groups (22.6, 14.0, and 22.8%, p = 0.04; and 37.6, 26.8, and 38.3%, p = 0.01, respectively). After adjusting for confounders, in the rivaroxaban group, the risk for major bleeding was numerically lower (hazard ratio [HR]: 0.65, 95% confidence interval [CI]: 0.40–1.01) and that of clinically relevant all bleeding was significantly lower (HR: 0.67, 95% CI: 0.48–0.92) than those in the edoxaban group.

Conclusion The risks of recurrent VTE and all-cause death did not differ significantly among the different DOACs ; however, the risk of bleeding events could differ, with a potentially lower risk of bleeding with rivaroxaban.

Keywords

venous thromboembolism - cancer-associated VTE - DOACs

Full Text

References

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Supplementary Material

Supplementary Material