Publications by authors named "Ikeda Nobutaka"
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.
Article Synopsis
- * 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.
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.
Background: The management of chronic thromboembolic pulmonary hypertension (CTEPH) has advanced significantly in recent years, thereby improving patient prognosis. However, the impact of cancer on the outcomes of patients with CTEPH under current treatment remains unclear. This study aimed to investigate the prevalence of cancer in patients with CTEPH and determine how comorbid cancer affects their prognosis and clinical course.
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- 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.
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.
Background: The contemporary outcome of balloon pulmonary angioplasty (BPA) and pulmonary endarterectomy (PEA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) are unclear.
Objectives: This study aimed to clarify the characteristics and outcomes of CTEPH patients treated with BPA and PEA in Japan.
Methods: Among 1,270 participants enrolled between 2018 and 2023 in the CTEPH AC (Chronic Thromboembolic Pulmonary Hypertension Anticoagulant) registry, a Japanese nationwide CTEPH registry, 369 treatment-naive patients (BPA strategy: n = 313; PEA strategy: n = 56) and 690 on-treatment patients (BPA strategy: n = 561; PEA strategy: n = 129) were classified according to the presence of prior reperfusion therapy.
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.
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
- Direct oral anticoagulants (DOACs) are commonly used for treating venous thromboembolism in cancer patients, yet they can lead to bleeding complications, particularly in those with gastrointestinal (GI) cancers.
- A study analyzed data from 1,149 cancer patients on DOACs to assess bleeding outcomes, showing that those with upper GI cancer had a higher incidence of major bleeding (22.4%) compared to those with lower GI (15.4%) and non-GI cancers (11.6%).
- The research concluded that upper GI cancer significantly increases the risk of major bleeding during anticoagulation therapy, unlike lower GI cancer, which had no significant difference in bleeding risk compared to non-GI cancers.
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
- The CLOT-COVID Study analyzed 2894 hospitalized patients with COVID-19, focusing on 1738 patients with mild cases who didn’t need oxygen at admission.
- Patients were split into two groups: those receiving prophylactic anticoagulation (326 patients) and those who were not (1412 patients).
- Results showed that those on anticoagulation had higher severity levels during hospitalization and a slightly higher incidence of thrombosis, suggesting that routine use may not be beneficial for all stable patients.
Introduction: There is limited data on the safety of direct oral anticoagulants (DOACs) in fragile patients with venous thromboembolism (VTE).
Materials And Methods: We used the COMMAND VTE Registry-2 enrolling patients with acute symptomatic VTE. The study population consisted of 3928 patients receiving DOACs, who were divided into fragile (2136 patients) and non-fragile groups (1792 patients).
Background: The multicenter, open-label, randomized clinical trial ONCO DVT compared 3-month and 12-month edoxaban treatment regimens for isolated distal deep vein thrombosis (DVT) and suggested potential benefits of prolonged edoxaban treatment in terms of thrombotic risk. However, the risk-benefit balance of prolonged edoxaban treatment in patients with renal function remains unclear.
Objectives: To compare the safety and efficacy of 3-month and 12-month edoxaban treatment regimens in patients with cancer-associated isolated distal DVT and different renal functions.
Background: There have been still limited data on the transition of management strategies and clinical outcomes after introduction of direct oral anticoagulant (DOAC) for cancer-associated venous thromboembolism (VTE) in the real-world clinical practice.
Methods: Using the 2 series of multicenter COMMAND VTE registries in Japan enrolling consecutive patients with acute symptomatic VTE, we compared 695 patients with cancer-associated VTE in the Registry-1 of the warfarin era and 1507 patients in the Registry-2 of the DOAC era.
Results: Regarding oral anticoagulation therapy, 576 patients (82.
Article Synopsis
- - The study investigated cancer-associated venous thromboembolism (VTE) management in patients treated with direct oral anticoagulants (DOACs) across 31 centers in Japan from 2015 to 2020, involving 5,197 patients.
- - Patients with active cancer showed a higher rate of discontinuing anticoagulation treatment (62.7%) compared to those without cancer (59.1%), and they experienced more major bleeding incidents over five years (20.4% vs. 11.6%).
- - After adjusting for other factors, although the recurrence of VTE was similar between both groups, the increased risk of major bleeding persisted in those with active cancer, highlighting ongoing challenges in managing antico
Article Synopsis
- The study investigates the ideal length of anticoagulation therapy for cancer patients with isolated distal deep vein thrombosis (DVT), comparing 12 months versus 3 months of edoxaban treatment, considering the balance between preventing thrombotic events and the risk of bleeding.
- A multicenter clinical trial included 601 patients, showing that longer treatment (12 months) significantly reduced the risk of recurrent venous thromboembolism (VTE) or VTE-related deaths compared to 3 months (1% vs. 7.2%).
- However, the incidence of major bleeding was slightly higher in the 12-month group (9.5%) versus the 3-month group (7.2%), indicating that while longer treatment is