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Risk factors for post-thrombotic syndrome in patients with deep vein thrombosis: from the COMMAND VTE registry

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Abstract

Post-thrombotic syndrome (PTS) is the most common chronic complication of deep vein thrombosis (DVT). Identifying high-risk patients for the development of PTS might be useful for its prevention. The COMMAND VTE Registry is a multicenter registry that enrolled 3027 consecutive patients with acute symptomatic venous thromboembolisms (VTEs) in Japan between January 2010 and August 2014. The current study population consisted of 1298 patients with lower extremities DVTs who completed 3-year follow-up for those who developed PTS and those without PTS. We investigated risk factors for the development of PTS at the time of DVT diagnosis, using a multivariable logistic regression analysis. Of the entire 1298 study patients, 169 (13%) patients were diagnosed with PTS within 3 years. The rate for anticoagulation discontinuation during follow-up was not significantly different between those with and without PTS. Chronic kidney disease (OR 2.21, 95% CI 1.45–3.39, P < 0.001), leg swelling (OR 4.15, 95% CI 2.25–7.66, P < 0.001), absence of transient risk factors for VTEs (OR 2.39, 95% CI 1.55–3.67, P < 0.001), active cancer (OR 3.66, 95% CI 2.30–5.84, P < 0.001), and thrombophilia (OR 2.07, 95% CI 1.06–4.04, P = 0.03) were independent risk factors for the development of PTS. In this real-world Japanese DVT registry, we could identify several important risk factors for the development of PTS at the time of DVT diagnosis.

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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. We also would like to express our gratitude to Mr. John Martin for his grammatical assistance.

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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Authors and Affiliations

  1. Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan

    Yuji Nishimoto, Syunsuke Saga & Yukihito Sato

  2. Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan

    Yugo Yamashita, Hiroki Shiomi, Takao Kato, Takeru Makiyama, Koh Ono & Takeshi Kimura

  3. Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan

    Takeshi Morimoto

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

    Hidewo Amano

  5. Department of Cardiology, Kinki University Hospital, Osaka, Japan

    Toru Takase

  6. Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan

    Seiichi Hiramori

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

    Kitae Kim

  8. Department of Cardiology, Japanese Red Cross Otsu Hospital, Otsu, Japan

    Maki Oi

  9. Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan

    Masaharu Akao

  10. Department of Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan

    Yohei Kobayashi

  11. Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan

    Mamoru Toyofuku

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

    Toshiaki Izumi

  13. Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan

    Tomohisa Tada

  14. Department of Cardiology, Osaka Saiseikai Noe Hospital, Osaka, Japan

    Po-Min Chen

  15. Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan

    Koichiro Murata

  16. Division of Cardiology, Shimada Municipal Hospital, Shimada, Japan

    Yoshiaki Tsuyuki

  17. Department of Cardiology, Kishiwada City Hospital, Kishiwada, Japan

    Tomoki Sasa

  18. Department of Cardiology, Tenri Hospital, Tenri, Japan

    Jiro Sakamoto

  19. Department of Cardiology, Nishikobe Medical Center, Kobe, Japan

    Minako Kinoshita

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

    Kiyonori Togi

  21. Department of Cardiology, Koto Memorial Hospital, Higashiomi, Japan

    Hiroshi Mabuchi

  22. Department of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan

    Kensuke Takabayashi

Authors
  1. Yuji Nishimoto
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  2. Yugo Yamashita
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  3. Takeshi Morimoto
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  8. Kitae Kim
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  13. Toshiaki Izumi
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  14. Tomohisa Tada
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  15. Po-Min Chen
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  17. Yoshiaki Tsuyuki
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  26. Takeru Makiyama
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  27. Koh Ono
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  28. Yukihito Sato
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  29. Takeshi Kimura
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The COMMAND VTE Registry Investigators

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Correspondence to Yugo Yamashita.

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Conflicts of interest

Dr. Yamashita received lecture fees from Daiichi-Sankyo, 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. Dr. Kimura serves as an advisory board member for Abbott Vascular and Terumo Company. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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Nishimoto, Y., Yamashita, Y., Morimoto, T. et al. Risk factors for post-thrombotic syndrome in patients with deep vein thrombosis: from the COMMAND VTE registry. Heart Vessels 34, 669–677 (2019). https://doi.org/10.1007/s00380-018-1277-3

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