Publications by authors named "Kazunori Otsui"

Background: Previous randomized clinical trials did not support a benefit of screening for occult cancer after diagnosis of venous thromboembolism (VTE), although screening may be of potential benefit for selected high-risk patients.

Methods And Results: The COMMAND VTE Registry-2 enrolled consecutive patients with acute symptomatic VTE between 2015 and 2020 from 31 centers across Japan. The 3,706 patients in the registry without known active cancer at the time of VTE diagnosis were divided into 2 groups: those with (n=250) and without (n=3,456) newly diagnosed cancer during the follow-up period.

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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.
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  • 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.
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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.
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  • * 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
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  • 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.
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  • * 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.
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  • 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.
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  • 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.
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  • 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.
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  • 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.
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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.

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  • 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.
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  • 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
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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).

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Stress has garnered significant attention as a prominent risk factor for inflammation-related diseases, particularly cardiovascular diseases (CVDs). However, the precise mechanisms underlying stress-driven CVDs remain elusive, thereby impeding the development of preventive and therapeutic strategies. To explore the correlation between plasma lipid metabolites and human depressive states, liquid chromatography-mass spectrometry (LC/MS) based analysis of plasma and the self-rating depression (SDS) scale questionnaire were employed.

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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.

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  • - 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
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  • 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
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  • A study called COMMAND VTE Registry-2 analyzed 5,197 patients in Japan with venous thromboembolism (VTE) to gather data on anticoagulation strategies and long-term recurrence from 2015 to 2020.
  • The study found that 79% of patients received direct oral anticoagulants (DOACs), with differing rates of discontinuation and recurrence based on risk factor groups, particularly showing the highest recurrence in the unprovoked group.
  • The findings suggest that understanding a patient's risk profile is crucial for making informed decisions about anticoagulation therapy, highlighting the need for tailored strategies especially concerning bleeding risks.
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Unlabelled: Fixed-ratio combination injection therapy (FRC) is a fixed-ratio mixture containing basal insulin and glucagon-like peptide-1 receptor agonist (GLP-1 RA) in a single injection for the treatment of patients with type 2 diabetes. The two types of FRC products contain different concentrations and mixing ratios of basal insulin and GLP-1 RA. Both products demonstrated satisfactory blood glucose control throughout the day, with less hypoglycemia and weight gain.

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A 38-year-old man with deep vein thrombosis associated with Behçet's disease (BD) was admitted to our hospital due to worsening symptoms despite the initiation of direct oral anticoagulants (DOACs). Administration of oral prednisolone and an intravenous anti-tumor necrosis factor-alpha (TNF-α) monoclonal antibody dramatically improved his symptoms. In addition, he was incidentally diagnosed with autosomal dominant polycystic kidney disease, which increases the risk of aortic aneurysms.

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Chronic hyperglycemia leads to a decrease in glucose-stimulated insulin secretion and an increase in insulin resistance. Resolving these glucose toxicities is pivotal in type 2 diabetes therapy because the decline in insulin secretion and insulin sensitivity causes further hyperglycemia. Conventionally, multiple daily insulin injection therapy was applied in such a situation.

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A 76-year-old man presented with a four-month history of progressive bilateral lower limb muscle weakness and dysesthesia. The patient had extravascular volume overload, and laboratory findings confirmed hypothyroidism, renal dysfunction, and chronic inflammation. Serum protein and immunofixation electrophoresis revealed biclonality of immunoglobulin A (IgA)-kappa and IgA-lambda, which was attributed to chronic inflammation.

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