Publications by authors named "Tomohiro Dohke"
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.
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.
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
- 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
- * 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.
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).
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
No predictive clinical risk scores for net adverse clinical events (NACE) have been developed for patients with atrial fibrillation (AF) after percutaneous coronary intervention (PCI). We evaluated NACE to develop clinically applicable risk-stratification scores in the Bleeding and thrombotic risk evaluation In patients With Atrial fibrillation under COronary intervention (BIWACO) study, a multicenter survey which has enrolled a total of 7837 patients. We also investigated the current status and time trends for the use of antithrombotic drugs.
View Article and Find Full Text PDFBackground: Because congestive heart failure (CHF) is a complex syndrome with many different underlying mechanisms of worsening of heart function, it is important to recognize the global alternations in protein expression associated with the processes of CHF.
Methods And Results: The purpose of our study was to use a proteomic approach to investigate global alternations in protein expression in tachycardia induced CHF dogs. We compared the 2-dimensional electrophoresis protein patterns of left ventricular samples from the normal with those from failing myocardium.
Objectives: This study sought to evaluate the relationship between brain natriuretic peptide (BNP), renal function, and the severity of congestive heart failure (CHF).
Background: Both BNP and renal function are prognostic predictors in CHF patients.
Methods: We measured the plasma BNP level in the aortic root and coronary sinus in 366 consecutive patients with CHF.
In congestive heart failure, angiotensin-converting enzyme inhibitors (ACEIs) may prevent cardiac fibrosis via interaction with both angiotensin II and endothelin-1, which enhance myocardial collagen synthesis. However, whether endogenous bradykinin with an ACEI modifies the cardiac collagen architecture, affecting the endothelin system, has not yet been fully elucidated. We evaluated the changes in circulating hormonal factors, myocardial fibrosis and cardiac gene expression closely linked with heart failure, using an orally active specific bradykinin type 2 receptor antagonist, FR173657 (0.
View Article and Find Full Text PDFBackground: It remains unclear whether tumor necrosis factor (TNF)-alpha and interleukin-6 (IL-6) are secreted from the failing heart and whether there is a relationship between the transcardiac gradients of these cytokines and left ventricular (LV) remodeling.
Aims: This study evaluated the relationship between transcardiac gradients of cytokines and LV volume and function in congestive heart failure patients with dilated cardiomyopathy (DCM).
Methods And Results: We measured the plasma levels of TNF-alpha and IL-6 in the aortic root (Ao) and the coronary sinus (CS) in 60 patients with DCM.