Clinical Characteristics and Outcomes of Venous Thromboembolisms According to an Out-of-Hospital vs. In-Hospital Onset　― From the COMMAND VTE Registry ―

Yuji Nishimoto; Yugo Yamashita; Takeshi Morimoto; Syunsuke Saga; Hidewo Amano; Toru Takase; Seiichi Hiramori; Kitae Kim; Maki Oi; Masaharu Akao; Yohei Kobayashi; Mamoru Toyofuku; Toshiaki Izumi; Tomohisa Tada; Po-Min Chen; Koichiro Murata; Yoshiaki Tsuyuki; Tomoki Sasa; Jiro Sakamoto; Minako Kinoshita; Kiyonori Togi; Hiroshi Mabuchi; Kensuke Takabayashi; Hiroki Shiomi; Takao Kato; Takeru Makiyama; Koh Ono; Yukihito Sato; Takeshi Kimura; on behalf of the COMMAND VTE Registry Investigators

doi:10.1253/circj.CJ-18-1314

Pulmonary Circulation

Clinical Characteristics and Outcomes of Venous Thromboembolisms According to an Out-of-Hospital vs. In-Hospital Onset　― From the COMMAND VTE Registry ―

Yuji Nishimoto, Yugo Yamashita, Takeshi Morimoto, Syunsuke Saga, Hidewo Amano, Toru Takase, Seiichi Hiramori, Kitae Kim, Maki Oi, Masaharu Akao, Yohei Kobayashi, Mamoru Toyofuku, Toshiaki Izumi, Tomohisa Tada, Po-Min Chen, Koichiro Murata, Yoshiaki Tsuyuki, Tomoki Sasa, Jiro Sakamoto, Minako Kinoshita, Kiyonori Togi, Hiroshi Mabuchi, Kensuke Takabayashi, Hiroki Shiomi, Takao Kato, Takeru Makiyama, Koh Ono, Yukihito Sato, Takeshi Kimura, on behalf of the COMMAND VTE Registry Investigators

Author information

Yuji Nishimoto
Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
Yugo Yamashita
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
Takeshi Morimoto
Department of Clinical Epidemiology, Hyogo College of Medicine
Syunsuke Saga
Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
Hidewo Amano
Department of Cardiovascular Medicine, Kurashiki Central Hospital
Toru Takase
Department of Cardiology, Kinki University Hospital
Seiichi Hiramori
Department of Cardiology, Kokura Memorial Hospital
Kitae Kim
Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital
Maki Oi
Department of Cardiology, Japanese Red Cross Otsu Hospital
Masaharu Akao
Department of Cardiology, National Hospital Organization Kyoto Medical Center
Yohei Kobayashi
Department of Cardiovascular Center, Osaka Red Cross Hospital
Mamoru Toyofuku
Department of Cardiology, Japanese Red Cross Wakayama Medical Center
Toshiaki Izumi
Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital
Tomohisa Tada
Department of Cardiology, Shizuoka General Hospital
Po-Min Chen
Department of Cardiology, Osaka Saiseikai Noe Hospital
Koichiro Murata
Department of Cardiology, Shizuoka City Shizuoka Hospital
Yoshiaki Tsuyuki
Division of Cardiology, Shimada Municipal Hospital
Tomoki Sasa
Department of Cardiology, Kishiwada City Hospital
Jiro Sakamoto
Department of Cardiology, Tenri Hospital
Minako Kinoshita
Department of Cardiology, Nishikobe Medical Center
Kiyonori Togi
Division of Cardiology, Nara Hospital, Kinki University Faculty of Medicine
Hiroshi Mabuchi
Department of Cardiology, Koto Memorial Hospital
Kensuke Takabayashi
Department of Cardiology, Hirakata Kohsai Hospital
Hiroki Shiomi
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
Takao Kato
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
Takeru Makiyama
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
Koh Ono
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
Yukihito Sato
Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
Takeshi Kimura
Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
on behalf of the COMMAND VTE Registry Investigators

Keywords: In-hospital onset, Out-of-hospital onset, Venous thromboembolism

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Supplementary material

2019 Volume 83 Issue 6 Pages 1377-1384

DOI https://doi.org/10.1253/circj.CJ-18-1314

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Abstract

Background: Differences in the clinical characteristics and outcomes of venous thromboembolisms (VTEs) based on different clinical situations surrounding the onset might be important for directing appropriate treatment strategies, but have not yet been appropriately evaluated.

Methods and Results: The COMMAND VTE Registry is a multicenter registry enrolling 3,027 consecutive patients with acute symptomatic VTEs in Japan between January 2010 and August 2014. We divided the study population into 3 groups: Out-of-hospital onset (n=2,308), In-hospital onset with recent surgery (n=310), and In-hospital onset without recent surgery (n=374). Active cancer was most prevalent in the In-hospital onset without recent surgery group, and least in the Out-of-hospital onset group (Out-of-hospital onset group: 20%, In-hospital onset with recent surgery group: 26%, and In-hospital onset without recent surgery group: 38%, P<0.001). The cumulative 5-year incidence of recurrent VTEs did not significantly differ across the 3 groups (11.4%, 5.8%, and 8.7%, respectively; P=0.11). The cumulative 5-year incidences of major bleeding and all-cause death were highest in the In-hospital onset without recent surgery group (11.1%, 8.5%, and 23.3%, P<0.001; 26.8%, 24.9%, and 48.4%, P<0.001, respectively).

Conclusions: In the real-world VTE registry, the clinical characteristics and long-term outcomes substantially differed according to the clinical situation of VTE onset, suggesting the need for different treatment strategies for VTEs in different clinical settings.

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