Publications by authors named "Daisuke Sueta"
Article Synopsis
- Previous trials suggest no overall benefit of screening for occult cancer in patients with venous thromboembolism (VTE), but high-risk patients may still benefit.
- A study involving 3,706 patients with acute VTE found that the incidence of newly diagnosed cancer increased over time, reaching 3.7% at one year and 7.0% at three years.
- Factors such as older age, a history of cancer, autoimmune disorders, past major bleeding, and lack of transient VTE risk factors were identified as independent predictors for new cancer diagnoses post-VTE.
Large scale randomized trials have shown that sodium-glucose co-transporter 2 (SGLT2) inhibitors can reduce cardiovascular events in patients with cardiovascular disease or with increased risks of cardiovascular disease. However, the evidence from older patients is limited. To compare the efficacy of SGLT2 inhibitors among non-older and older patients we have searched PubMed, Cochrane Central, and Embase until February 2023 for randomized controlled trials (RCTs) investigating SGLT2 inhibitors in older (age ≥ 65 years) patients with diabetes mellitus, chronic kidney disease, and chronic heart failure.
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- * Out of 1507 cancer patients studied, 4.7% experienced an ischemic stroke over a median follow-up of 1020 days, with a cumulative incidence of 4.0% at 1 year.
- * Key risk factors for stroke include specific cancers (pancreatic, ovarian, lung), dyslipidemia, metastasis, elevated D-dimer levels, and younger age, highlighting the need for vigilant monitoring in these patients.
Background: The optimal duration of anticoagulation therapy for patients with cancer and acute low-risk pulmonary embolism (PE) is clinically relevant, but evidence is lacking. Prolonged anticoagulation therapy could have a potential benefit for prevention of thrombotic events; however, it could also increase the risk of bleeding.
Methods: In a multicenter, open-label, adjudicator-blinded, randomized clinical trial at 32 institutions in Japan, we randomly assigned patients with cancer and acute low-risk PE of the simplified version of the Pulmonary Embolism Severity Index score of 1, in a 1:1 ratio, to receive either an 18-month or a 6-month rivaroxaban treatment.
Article Synopsis
- Extracorporeal membrane oxygenation (ECMO) may be necessary for some patients with severe pulmonary embolism (PE), but its clinical outcomes are not well understood.
- *In a study analyzing data from 2035 patients with acute PE, 76 required ECMO, with findings indicating high rates of cardiac arrest (88.2%) at diagnosis and a 30-day death rate of 30.3%, all related to PE.
- *The research highlighted significant complication rates, including a 54% incidence of major bleeding, suggesting the need for improved management strategies and future clinical trials.
Article Synopsis
- Elevated white blood cell (WBC) counts are identified as a risk factor for adverse outcomes in patients with venous thromboembolism (VTE) who do not have active cancer.
- In a study involving 5,197 patients, those with the highest WBC counts (Q4) were more likely to experience severe forms of VTE like pulmonary embolism and had a significantly higher risk of death and major bleeding over five years.
- The findings suggest that monitoring WBC counts at VTE diagnosis can help in assessing patient risk and potential outcomes.
Article Synopsis
- * The COMMAND VTE Registry-2 study tracked 5,197 patients with venous thromboembolism in Japan, finding that 2.3% of those with acute PE developed CTEPH over an average follow-up of 747 days.
- * Identified risk factors for developing CTEPH included being female, longer time from symptom onset to PE diagnosis, experiencing hypoxemia, having right heart load, lower D-dimer levels, and having
Article Synopsis
- The simplified Pulmonary Embolism Severity Index (sPESI) score helps identify low-risk patients for home treatment of pulmonary embolism, but its use with direct oral anticoagulants hasn't been thoroughly studied.
- A study of 2,496 patients with stable pulmonary embolism found that only 25% had an sPESI score of 0, and among those, only 17% were treated at home, though their 30-day mortality was notably low (0% vs. 4.8% in higher risk groups).
- Factors promoting home treatment included the absence of temporary risk factors, no elevated cardiac biomarkers, and the use of direct oral anticoagulants during the acute phase.
Background: Despite strong recommendations in the latest guidelines for implementing guideline-directed medical therapy (GDMT) before discharge, there is a lack of data on the clinical characteristics and outcomes of older patients with heart failure (HF). Therefore, this study aimed to investigate the clinical characteristics and outcomes of patients with HF in a super-aging society during the GDMT era.
Methods And Results: In the COMPASS-HF study including 305 consecutive hospitalized patients, 177 with acute HF were identified through a medical record review.
Article Synopsis
- * In a subgroup analysis of 601 patients, those with anemia showed significantly fewer recurrent venous thromboembolism (VTE) cases with 12-month edoxaban treatment compared to 3 months, while no such reduction was observed in patients without anemia.
- * Overall, 12-month edoxaban treatment was more effective in preventing thrombotic events for both anemia and no-anemia groups, with no significant difference in major bleeding risk between the two treatment durations.
Article Synopsis
- The ONCO DVT study found that a 12-month course of edoxaban is more effective than a 3-month course for preventing thrombotic events in cancer patients with isolated distal deep vein thrombosis (DVT).
- This analysis categorized 601 patients into three groups based on their modified Ottawa score (low, intermediate, high) to determine the effectiveness of extended anticoagulation.
- Results showed that extended treatment significantly reduced thrombotic events in the intermediate and high score groups but not in the low score group, indicating limited benefit for those with a low risk.
Article Synopsis
- A study in Japan compared outcomes of patients with venous thromboembolism (VTE) treated with warfarin (2010-2014) versus direct oral anticoagulants (DOACs) (2015-2020) from two multicenter registries.
- The use of DOACs skyrocketed from 2.6% in the warfarin era to 79% in the DOAC era, leading to a significant reduction in the 5-year recurrence rate of VTE (10.5% to 9.5%).
- However, the incidence of major bleeding remained similar between the two eras, indicating that while DOACs may reduce VTE recurrence, concerns about bleeding risks continue.
Article Synopsis
- The PE-SARD bleeding score was developed to predict early major bleeding in patients with pulmonary embolism (PE) but has not been fully validated externally.
- A study using data from the COMMAND VTE Registry involving 2,781 acute PE patients categorized them into high, intermediate, and low-risk groups based on this score, revealing a clear increase in bleeding rates with higher risk scores.
- The results indicated the score has modest effectiveness in predicting bleeding risk overall, with better performance in patients without active cancer.
Aims: Wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM) is often accompanied by atrial fibrillation (AF), atrial flutter (AFL), and atrial tachycardia (AT), which are difficult to control because beta-blockers and antiarrhythmic drugs can worsen heart failure (HF). This study aimed to investigate the outcomes of catheter ablation (CA) for AF/AFL/AT in patients with ATTRwt-CM and propose a treatment strategy for CA.
Methods And Results: A cohort study was conducted on 233 patients diagnosed with ATTRwt-CM, including 54 who underwent CA for AF/AFL/AT.
Background: Although the prevalence rate of valvular heart disease (VHD) is high in patients with systemic lupus erythematosus (SLE), the predictive factors of concomitant VHD have not been fully evaluated.
Methods And Results: Among 288 patients with SLE who underwent transthoracic echocardiography at Kumamoto University Hospital from 2016 to 2021, 241 patients with sufficient echocardiographic data were retrospectively analysed. Among them, 22 (9 %) had VHD (10 had mitral regurgitation, 3 had aortic regurgitation, 6 had tricuspid regurgitation, 1 had mitral regurgitation and tricuspid regurgitation, and 2 had a prosthetic cardiac valve).
Article Synopsis
- Statins are suggested to help prevent recurrent venous thromboembolism (VTE), based on findings from a large study of over 5,000 VTE patients in Japan.
- The study divided patients into two groups based on statin use at discharge, revealing that the group using statins had a significantly lower incidence of recurrent VTE compared to the non-statin group (6.8% vs. 10.1%) over five years.
- Although statins also showed a trend towards reducing major bleeding risk, this was not statistically significant after adjusting for confounding factors.
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 ( = 643, 54%), rivaroxaban ( = 297, 25%), and apixaban ( = 257, 22%) groups.
Article Synopsis
- Researchers studied unprovoked venous thromboembolisms (VTEs) in a large registry to identify distinct patient phenotypes using latent class analysis (LCA).
- The study classified patients into three subgroups based on age and health conditions: younger patients, older patients with few comorbidities, and older patients with many comorbidities.
- Findings revealed differences in treatment outcomes, with higher anticoagulation discontinuation and bleeding risks in older patients with more comorbidities, suggesting tailored management strategies could improve patient care.
Article Synopsis
- The ONCO DVT study showed that a 12-month treatment with edoxaban is more effective than a 3-month treatment for preventing blood clots in patients with cancer-associated isolated distal deep vein thrombosis (DVT).
- In a subgroup analysis, both standard (60 mg/day) and reduced (30 mg/day) dosages of edoxaban had lower rates of recurrent blood clots in those treated for 12 months compared to 3 months, but the risk of major bleeding was higher for the standard dose over 12 months.
- Overall, while a longer duration of edoxaban treatment is beneficial for reducing thrombotic risk, there is a cautionary note about increased bleeding risks with the higher dosage over extended periods
Article Synopsis
- Current guidelines suggest using several direct oral anticoagulants (DOACs) for treating cancer-related venous thromboembolism (VTE), but the study aims to investigate their safety and efficacy specifically for patients with active cancer.
- A systematic review of 17 randomized controlled trials with over 6,600 patients revealed no major differences in how well the DOACs worked for preventing recurrent VTE or pulmonary issues.
- While apixaban showed a lower risk of major bleeding compared to edoxaban, it effectively reduced VTE recurrence versus parenteral anticoagulation; however, rivaroxaban was linked to a higher chance of bleeding complications.
Neither the efficacy nor safety of elobixibat has been investigated in the treatment of chronic constipation in patients with heart failure (HF). In this prospective, single-center, single-arm study elobixibat (10 mg/day) was administered for 12 weeks to 18 HF patients with chronic constipation defined according to the Rome IV criteria. Spontaneous bowel movement (SBM), stool consistency as measured by the Bristol Stool Form Scale, and degree of straining during defecation were recorded.
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- * Out of 178 patients, 37% received home treatment, with low rates of serious complications: 4.6% had major bleeding, but there were no deaths or recurrent PE in this group.
- * The findings suggest that certain cancer patients with low-risk PE could safely manage their treatment at home instead of in a hospital setting.