scholarly journals Venous thromboembolism in the elderly

2008 ◽  
Vol 100 (05) ◽  
pp. 780-788 ◽  
Author(s):  
Joel M. Gore ◽  
Darleen Lessard ◽  
Cathy Emery ◽  
Luigi Pacifico ◽  
George Reed ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Major Bleeding ◽  
Clinical Characteristics ◽  
Management Practices ◽  
The Elderly ◽  
Population Based ◽  
Long Term Outcomes ◽  
Recurrent Vte ◽  
The Impact

SummaryWhile the magnitude of venous thromboembolism (VTE) increases dramatically with advancing age,relatively little is known about the contemporary management of VTE in the elderly and the impact of age on associated short- and long-term outcomes. The objectives of this population-based study were to compare the clinical characteristics,treatment practices,and outcomes of subjects ≥65 years with VTE to those of younger patients.The medical records of residents of the Worcester (MA, USA) metropolitan area with ICD-9 codes consistent with VTE during 1999, 2001, and 2003 were independently validated and reviewed by trained data abstractors. Information about patients’ demographic and clinical characteristics, hospital management practices, and hospital and long-term outcomes was collected. There were a total of 1,897 validated events of VTE – 1,048 (55%) occurred in patients ≥65 years of age. Patients ≥65 years were less likely to have “unprovoked” VTE than younger patients.They were less likely to receive parenteral anticoagulation or warfarin as acute treatment. Rates of recurrent VTE did not differ significantly between patients 65 years of age or older compared to younger patients but the adjusted rates of major bleeding were increased approximately two-fold in older patients. In conclusion, advancing age is not a predictor of recurrent VTE but is associated with a significant increase in major bleeding episodes. Physicians treating elderly patients with VTE should continue to base their decisions on clinical characteristics previously shown to impact the risk of recurrent VTE. These decisions must be tempered by our observation that major bleeding occurs frequently in these patients.

Epidemiology of first and recurrent venous thromboembolism: A population-based cohort study in patients without active cancer

2014 ◽  
Vol 112 (08) ◽  
pp. 255-263 ◽  
Author(s):  
Alexander T. Cohen ◽  
Luke Bamber ◽  
Stephan Rietbrock ◽  
Carlos Martinez
Keyword(s):  
Cohort Study ◽  
Venous Thromboembolism ◽  
The Elderly ◽  
Population Based ◽  
Incidence Rates ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Recurrence Rates ◽  
Recurrent Vte ◽  
Active Cancer

SummaryContemporary data from population studies on the incidence and complications of venous thromboembolism (VTE) are limited. An observational cohort study was undertaken to estimate the incidence of first and recurrent VTE. The cohort was identified from all patients in the UK Clinical Practice Research Datalink (CPRD) with additional linked information on hospitalisation and cause of death. Between 2001 and 2011, patients with first VTE were identified and the subset without active cancer-related VTE observed for up to 10 years for recurrent VTE. The 10-year cumulative incidence rates (CIR) were derived with adjustment for mortality as a competing risk event. A total of 35,373 first VTE events (12,073 provoked, 16,708 unprovoked and 6592 active cancer-associated VTE) among 26.9 million person-years of observation were identified. The overall incidence rate (IR) of VTE was 131.5 (95% CI, 130.2–132.9) per 100,000 person-years and 107.0 (95% CI, 105.8–108.2) after excluding cancer-associated VTE. DVT was more common in the young and PE was more common in the elderly. VTE recurrence occurred in 3671 (CIR 25.2%). The IR for recurrence peaked in the first six months at around 11 per 100 person years. It levelled out after three years and then remained at around 2 per 100 person years from year 4–10 of follow-up. The IRs for recurrences were particularly high in young men. In conclusion, VTE is common and associated with high recurrence rates. Effort is required to prevent VTE and to reduce recurrences.

scholarly journals One-Year Outcomes with Once or Twice Daily Enoxaparin

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4968-4968
Author(s):  
Adi J. Klil-Drori ◽  
Sara Nazha ◽  
Marlene Gharib ◽  
Sylvie Perreault ◽  
Vicky Tagalakis
Keyword(s):  
Cohort Study ◽  
Major Bleeding ◽  
Research Funding ◽  
Population Based ◽  
Long Term Outcomes ◽  
Once Daily ◽  
Intention To Treat ◽  
One Year

Background: Enoxaparin given once daily (QD) for thrombotic disorders is less burdensome than twice-daily (BID) dosing. However, long-term outcomes when enoxaparin given as QD monotherapy are unknown. Methods: We did a population-based cohort study. New users of enoxaparin alone (2005-2014) were identified in the linked healthcare databases of Quebec, Canada, and followed up for up to one year. The number of dispensed syringes divided by prescription length determined QD or BID enoxaparin by intention to treat. Cumulative rates of major bleeding and re-treatment with anticoagulants at one year were compared between enoxaparin groups. Re-treatment was initiation of anticoagulation after at least 30 days of no dispensed anticoagulants. The duration of enoxaparin monotherapy was the sum of prescriptions until discontinuation. Results: The cohort included 504 patients; QD and BID enoxaparin users were 445 and 59, respectively. Mean (SD) age was 78.0 (6.6) years, 43.8% were males, and 61.9% had cancer. At 12 months, major bleeding occurred in 21 (4.7%) and 4 (6.8%) among QD and BID enoxaparin users, respectively (Figure 1A, P = 0.49). Re-treatment with anticoagulants occurred in 37 (9.6%) and 5 (9.4%) of QD and BID users, respectively (Figure 1B, P = 0.98). The duration of enoxaparin monotherapy was on average 13.9 (95% CI, 4.4-23.4, P = 0.005) days longer with QD vs BID use. Conclusions: Monotherapy with QD enoxaparin was common and longer than BID enoxaparin with no apparent differences in bleeding or re-treatment with anticoagulants. Figure 1 Disclosures Klil-Drori: Sanofi Canada: Research Funding. Nazha:Sanofi Canada: Employment. Gharib:Sanofi Canada: Employment. Perreault:Sanofi Canada: Research Funding. Tagalakis:Servier: Other: participated on ad boards; Bayer: Other: participated on ad boards; Pfizer: Other: participated on ad boards; Sanofi Aventis: Other: investigator initiated grant;participated on ad boards; BMS-Pfizer: Other: participated on ad boards.

scholarly journals Enoxaparin Dosing for Venous Thromboembolism Prophylaxis in Low Body Weight Patients

2019 ◽  
Vol 12 ◽  
pp. 1179545X1986381 ◽  
Author(s):  
Daniel Dybdahl ◽  
Grant Walliser ◽  
Michelle Pershing ◽  
Christy Collins ◽  
David Robinson
Keyword(s):  
Body Weight ◽  
Venous Thromboembolism ◽  
Major Bleeding ◽  
The Elderly ◽  
Primary Objective ◽  
Minor Bleeding ◽  
Bleeding Events ◽  
Thromboembolism Prophylaxis ◽  
Vte Prophylaxis ◽  
The Impact

Background: The appropriate dose of enoxaparin for venous thromboembolism (VTE) prophylaxis in low body weight patients is unknown. Objective: The aim of this study is to evaluate the impact of enoxaparin dosing on major and minor bleeding events in low body weight patients. Methods: This was a retrospective cohort study of patients weighing less than 45 kg receiving subcutaneous (SC) enoxaparin for VTE prevention. The primary objective was to determine whether enoxaparin dose was associated with major and minor bleeding. The secondary objective was to determine the incidence of VTE by enoxaparin dose. Results: There were 173 patients included in the study, of which 37 patients received 2 different courses of enoxaparin during hospitalization, resulting in 210 enoxaparin courses. Among all enoxaparin courses, 16.2% were associated with major bleeding and 5.2% with minor bleeding. There was no difference in the incidence of major bleeding by dose (enoxaparin 30 mg SC daily, 30 mg SC twice daily, or 40 mg SC daily; P = .409). Patients who experienced major bleeding were older (54.9 ± 16.1 years) than patients who did not (48.4 ± 18.4 years) ( P = .043). There was no difference in the incidence of minor bleeding by dosing schedule ( P = .14). No patients experienced a VTE. Conclusion and Relevance: The risk of bleeding was similar by enoxaparin dose but increased with age in low body weight patients. Given the low incidence of VTE in this study, it is reasonable to consider decreasing the prophylactic enoxaparin dose in low body weight patients, especially in the elderly population.

scholarly journals Who should get long-term anticoagulant therapy for venous thromboembolism and with what?

Hematology ◽  
2018 ◽  
Vol 2018 (1) ◽  
pp. 426-431 ◽  
Author(s):  
Marc Alan Rodger ◽  
Gregoire Le Gal
Keyword(s):  
Clinical Practice ◽  
Venous Thromboembolism ◽  
Anticoagulant Therapy ◽  
Major Bleeding ◽  
Major Surgery ◽  
Routine Practice ◽  
Difficult Decision ◽  
Trade Offs ◽  
Recurrent Vte

Abstract After an initial 3 to 6 months of anticoagulation for venous thromboembolism (VTE), clinicians and patients face an important question: “Do we stop anticoagulants or continue them indefinitely?” The decision is easy in some scenarios (eg, stop in VTE provoked by major surgery). In most scenarios, which are faced on a day-to-day basis in routine practice, it is a challenging decision because of uncertainty in estimates in the long-term risks (principally major bleeding) and benefits (reducing recurrent VTE) and the tight trade-offs between them. Once the decision is made to continue, the next question to tackle is “Which anticoagulant?” Here again, it is a difficult decision because of the uncertainty with regard to estimates of efficacy and the safety of anticoagulant options and the tight trade-offs between choices. We conclude with the approach that we take in our clinical practice.

Renal Impairment, Recurrent Venous Thromboembolism and Bleeding in Cancer Patients with Acute Venous Thromboembolism—Analysis of the CATCH Study

2018 ◽  
Vol 118 (05) ◽  
pp. 914-921 ◽  
Author(s):  
Agnes Lee ◽  
Pieter Kamphuisen ◽  
Guy Meyer ◽  
Mette Janas ◽  
Mikala Jarner ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Renal Impairment ◽  
Major Bleeding ◽  
Open Label ◽  
Exact Test ◽  
Patients With Cancer ◽  
Recurrent Vte ◽  
Cancer Associated Thrombosis ◽  
Acute Venous Thromboembolism ◽  
The Impact

Objective This article assesses the impact of renal impairment (RI) on the efficacy and safety of anticoagulation in patients with cancer-associated thrombosis from the Comparison of Acute Treatments in Cancer Hemostasis (CATCH) study (NCT01130025). Materials and Methods Renal function was assessed using the Modification of Diet in Renal Disease equation in patients with cancer-associated thrombosis who received either tinzaparin (175 IU/kg) once daily or warfarin for 6 months, in an open-label, randomized, multi-centre trial with blinded adjudication of outcomes. Associations between baseline RI (glomerular filtration rate [GFR] <60 mL/min/1.73m2) and recurrent symptomatic or incidental venous thromboembolism (VTE), clinically relevant bleeding (CRB), major bleeding and death were assessed using Fisher's exact test. Results Baseline-centralized GFR data were available for 864 patients (96% of study population). RI was found in 131 patients (15%; n = 69 tinzaparin). Recurrent VTE occurred in 14% of patients with and 8% of patients without RI (relative risk [RR] 1.74; 95% confidence interval [CI] 1.06, 2.85), CRB in 19% and 14%, respectively (RR 1.33; 95% CI 0.90, 1.98), major bleeding in 6.1% and 2.0%, respectively (RR 2.98; 95% CI 1.29, 6.90) and mortality rate was 40% and 34%, respectively (RR 1.20; 95% CI 0.94, 1.53). Patients with RI on tinzaparin showed no difference in recurrent VTE, CRB, major bleeding or mortality rates versus those on warfarin. Conclusion RI in patients with cancer-associated thrombosis on anticoagulation was associated with a statistically significant increase in recurrent VTE and major bleeding, but no significant increase in CRB or mortality. No differences were observed between long-term tinzaparin therapy and warfarin.

scholarly journals Impact of acute kidney injury on long-term adverse outcomes in obstructive uropathy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jihyun Yang ◽  
Bong Gyun Sun ◽  
Hyeon-Jin Min ◽  
Young-Bin Son ◽  
Tae Bum Kim ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Clinical Characteristics ◽  
Obstructive Uropathy ◽  
Kidney Injury ◽  
Progression Rate ◽  
Long Term Outcomes ◽  
Malignant Obstruction ◽  
The Impact

AbstractObstructive uropathy is known to be associated with acute kidney injury (AKI). This study aimed to investigate the etiologies, clinical characteristics, consequences and also assess the impact of AKI on long-term outcomes. This multicenter, retrospective study of 1683 patients with obstructive uropathy who underwent percutaneous nephrostomy (PCN) analyzed clinical characteristics, outcomes including progression to end-stage kidney disease (ESKD), overall mortality, and the impact of AKI on long-term outcomes. Obstructive uropathy in adults was most commonly caused by malignancy, urolithiasis, and other causes. AKI was present in 78% of the patients and was independently associated with preexisting chronic kidney disease (CKD). Short-term recovery was achieved in 56.78% after the relief of obstruction. ESKD progression rate was 4.4% in urolithiasis and 6.8% in other causes and older age, preexisting CKD, and stage 3 AKI were independent factors of progression. The mortality rate (34%) was highly attributed to malignant obstruction (52%) stage 3 AKI was also an independent predictor of mortality in non-malignant obstruction. AKI is a frequent complication of adult obstructive uropathy. AKI negatively affects long-term kidney outcomes and survival in non-malignant obstructions. A better understanding of the epidemiology and prognostic factors is needed for adult obstructive uropathy.

Impact of Thrombophilia Screening On Venous Thromboembolism Management Practices

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1158-1158 ◽  
Author(s):  
Jameel Abdulrehman ◽  
Jay Taylor ◽  
Shobha Sharma ◽  
Michael J. Kovacs ◽  
Alejandro Lazo-Langner
Keyword(s):  
Venous Thromboembolism ◽  
Survival Data ◽  
Management Practices ◽  
Recurrence Risk ◽  
Cox Regression Analysis ◽  
Thrombophilia Screening ◽  
Secondary Outcomes ◽  
The Impact ◽  
Term Management

Abstract Abstract 1158 BACKGROUND In patients with idiopathic venous thromboembolism (VTE) thrombophilia screening (TS) is usually done with the aim of helping to guide long term management. Since 2008 our center has modified clinical practice and decisions on long term management have been based on the findings of the REVERSE study (Rodger et al., CMAJ 2008), which stratifies recurrence risk based on clinical and laboratory risk factors excluding thrombophilia (TPh). We therefore aimed to study the current impact of TS on VTE management practices, particularly since the advent of the REVERSE study. METHODS We conducted a single-center, retrospective cohort study of all patients with objectively confirmed VTE who were consecutively referred to our thrombosis clinic from January 1st, 1999 to December 31st 2011. Patients were excluded if the VTE was due to hospital stay, pregnancy, immobility, or surgery. The primary outcome was the decision of maintaining anticoagulation (AC) beyond the initial planned period (6 months after VTE) based on TS. Secondary outcomes included decision of maintaining AC based on REVERSE criteria or other reasons, and incidence of recurrent VTE. Major TPh was defined as any of: confirmed antithrombin, protein S or protein C deficiencies, persistently positive anticardiolipin antibodies or lupus anticoagulant, or homozygote/compound heterozygote carriers of the Factor V Leiden or G20210A prothrombin gene variant. According to the year of diagnosis patients were divided in groups before and after 2008. Groups were compared using χ2 or Fisher's exact tests, as appropriate. Survival data was analyzed using the Kaplan-Meier method and Cox regression analysis. RESULTS We included 1033 out of 1100 eligible patients. Mean age was 55.59 years (SD 17.96), the mean length of follow up was 55.5 months (range 0 to 229), and 48.11% were female. Of 880 (85.2%) known family histories, 12.39% were positive for a previous VTE. Results for TPh testing and primary and secondary outcomes are shown in Tables 1 and 2. Overall, the proportion of patients continuing AC based on TS was small. After 2008, the majority of patients continuing OAT were based on REVERSE criteria. Compared to patients without TPh and after adjusting for AC continuation beyond 6 months, the presence of non-major TPh resulted in a modest increase in VTE recurrence risk (OR 1.71, 95% CI 1.20–2.44; P<0.01) whereas the presence of major TPh did not (OR 0.55, 95% CI 0.19–2.44; P=0.27). Continuation of AC beyond the initial planned period resulted in 75% reduction in VTE recurrence risk (OR 0.25, 95%CI 0.12–0.55; P<0.001). CONCLUSIONS The impact of TPh on VTE recurrence is small and the proportion of patients in whom TS results in long term AC is low. Furthermore, current decisions of AC duration are based on clinical criteria and might impact the risk of VTE recurrence to a greater extent than TS. Although at present TS seems to have a less preponderant role in management decisions, it might be of value for counseling purposes. Disclosures: Lazo-Langner: Pfizer: Honoraria; Leo Pharma: Honoraria.

scholarly journals Population-based Study of Long-term Anticoagulation for Treatment and Secondary Prophylaxis of Venous Thromboembolism in Men With Prostate Cancer in Sweden

2021 ◽  
Author(s):  
Yanina Balabanova ◽  
Bahman Farahmand ◽  
Pär Stattin ◽  
Hans Garmo ◽  
Gunnar Brobert
Keyword(s):  
Prostate Cancer ◽  
Venous Thromboembolism ◽  
Major Bleeding ◽  
Cox Regression ◽  
Epidemiological Data ◽  
Population Based ◽  
Secondary Prophylaxis ◽  
Treatment Cessation ◽  
Vein Thrombosis ◽  
Recurrent Vte

Abstract Background: Epidemiological data on anticoagulation for venous thromboembolism (VTE) in prostate cancer are sparse. We aimed to investigate associations between anticoagulation duration and risks of VTE recurrence after treatment cessation and major on-treatment bleeding in men with prostate cancer in Sweden. Methods: Using nationwide prostate cancer registry and prescribing data, we followed 1413 men with VTE and an outpatient anticoagulant prescription following prostate cancer diagnosis. Men were followed to identify cases of recurrent VTE, and hospitalized major bleeding. We calculated adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) to quantify the association between anticoagulation duration (reference ≤3 months) and recurrent VTE using Cox regression. We estimated 1-year cumulative incidences of major bleedings from anticoagulation initiation.Results: The outpatient anticoagulation prescribed was parenteral (64%), direct oral anticoagulant (31%), and vitamin K antagonist (20%). Median duration of anticoagulation was 7 months. Adjusted HRs (95% CI) for off-treatment recurrent pulmonary embolism (PE) were 0.32 (0.09–1.15) for >3–6 months’ duration, 0.21 (0.06–0.69) for >6–9 months and 0.16 (0.05–0.55) for >9 months; corresponding HRs for deep vein thrombosis (DVT) were 0.67 (0.27–1.66), 0.80 (0.31–2.07), and 1.19 (0.47–3.02). One-year cumulative incidences of intracranial, gastrointestinal and urogenital bleeding were 0.9%, 1.7%, 3.0% during treatment, and 1.2%, 0.9%, 1.6% after treatment cessation.Conclusion: The greatest benefit in reducing recurrent VTE risk was with >9 months anticoagulation for PE and >3–6 months for DVT. Risks of major bleeding were low not being substantially different to the risks after treatment cessation.

P2770Clinical characteristics and outcomes of venous thromboembolism according to patients with versus without atrial fibrillation: from the COMMAND VTE Registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Oi ◽  
Y Yamashita ◽  
T Morimoto ◽  
H Amano ◽  
T Takase ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Venous Thromboembolism ◽  
Major Bleeding ◽  
Clinical Characteristics ◽  
Oral Anticoagulants ◽  
Management Strategies ◽  
Anticoagulation Therapy ◽  
History Of ◽  
Study Population ◽  
Recurrent Vte

Abstract Background/Introduction Oral anticoagulants are widely used for the treatment and second prevention of venous thromboembolism (VTE) and stroke prevention in atrial fibrillation (AF). VTE and AF are common diseases and these sometimes might coexist. However, there are few reports about the relationship between VTE and AF. Purpose We sought to evaluate the clinical characteristics and outcomes in VTE patients with AF. Methods The COMMAND VTE Registry is a multicenter registry enrolling consecutive 3027 patients with acute symptomatic VTE objectively confirmed by imaging examination or by autopsy among 29 centers in Japan between January 2010 and August 2014. The current study population consisted of 129 patients with AF (AF group) and 2898 patients without AF (non-AF group). We compared the clinical characteristics, management strategies and long-term outcomes between the 2 groups. Results The AF group was older (mean age: 75.3 vs. 66.8 years, P<0.001), and more often had co-morbidities such as hypertension (54.3% vs. 37.7%, P<0.001), diabetes mellitus (20.2% vs. 12.4%, P=0.01), chronic kidney disease (28.7% vs. 18.5%, P=0.004), heart failure (28.7% vs. 18.5%, P=0.004), history of stroke (20.2% vs. 8.4%, P<0.001), and history of major bleeding (12.4% vs. 7.4%, P=0.04) compared with the non-AF group, whereas there were no significant differences in the proportions of active cancer at diagnosis (18.6% vs. 23.2%, P=0.23) and pulmonary embolism at presentation (64.3% vs. 56.3%, P=0.07). The proportion of anticoagulation therapy beyond acute phase was not significantly different (94% vs. 93%, P=0.60), while the cumulative discontinuation rates of anticoagulation therapy was significantly lower in the AF group (26.9% vs. 43.4% at 3 years, Log-rank P=0.03). The cumulative 5-year incidences of recurrent VTE and major bleeding were not significantly different (Recurrent VTE: 7.6% vs. 10.6%, Log-rank P=0.89; Major bleeding: 18.6% vs. 11.8%, Log-rank P=0.07). After adjusting for potential confounders, the risks of the AF group relative to the non-AF group for recurrent VTE and major bleeding remained insignificant (HR 1.19, 95% CI 0.54–2.28, P=0.64; HR 1.28, 95% CI 0.73–2.06, P=0.37). The cumulative 5-year incidence of all-cause death was significantly higher in the AF-group (49.1% vs. 28.6%, Log-rank P<0.001). After adjusting for potential confounders, the risks of the AF group relative to the non-AF group for all-cause death remained significant (HR 1.63, 95% CI 1.23–2.15, P<0.001). The proportion of deaths due to cancer was lower in the AF group (30% vs. 55%, P<0.001), while the proportion of cardiac deaths was higher in the AF group (16.1% vs. 4.0%, P<0.001). The outcomes of VTE patients with AF Conclusions The risks for recurrent VTE between patients with AF and those without AF were not significantly different, although patients with AF received longer-term anticoagulation therapy, whereas the risks for major bleeding tended to be higher in patients with AF. Acknowledgement/Funding Research Institute for Production Development, Mitsubishi Tanabe Pharma Corporation

P3847Deep vein thrombosis in upper extremities: clinical characteristics, management strategies and long-term outcomes from the COMMAND VTE Registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y Yamashita ◽  
T Morimoto ◽  
H Amano ◽  
T Takase ◽  
S Hiramori ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Management Strategies ◽  
Anticoagulation Therapy ◽  
Lower Extremities ◽  
Venous Catheter ◽  
Upper Extremities ◽  
Long Term Outcomes ◽  
Vein Thrombosis ◽  
Recurrent Vte

Abstract Background/Introduction Pulmonary embolism (PE) is caused by blockage of pulmonary arteries by thrombus. The sources of thrombus are thought to be mostly veins in lower extremities, whereas deep vein thrombosis (DVT) in upper extremities rarely occurs spontaneously. Recent studies reported that DVT in upper extremities might have significant complications, and DVT in upper extremities could be increasing. However, there is a paucity of data on patients with DVT in upper extremities, leading to uncertainty in optimal treatment strategies including anticoagulation therapy. Purpose We sought to evaluate the clinical characteristics, management strategies, and long-term outcomes of patients with DVT in upper extremities in a large observational database in Japan. Methods The COMMAND VTE Registry is a multicenter registry enrolling 3027 consecutive patients with acute symptomatic venous thromboembolism (VTE) objectively confirmed by imaging examination or by autopsy among 29 centers in Japan between January 2010 and August 2014. The current study population consisted of 2498 patients with DVT in upper or lower extremities, after excluding 381 patients with PE only, 144 patients who had thrombus in locations other than upper or lower extremities, and 4 patients with DVT in both upper and lower extremities. The study patients were divided into 2 groups: patients with DVT in upper extremities and patients with DVT in lower extremities. We compared the clinical characteristics, management strategies and long-term outcomes between the 2 groups. Results There were 74 patients (3.0%) with upper extremities DVT and 2498 patients (97%) with lower extremities DVT. Patients with upper extremities DVT more often had active cancer at diagnosis (58%) and central venous catheter use (22%). The proportion of concomitant PE at diagnosis was lower in patients with upper extremities DVT than in those with lower extremities DVT (14% and 51%, P<0.001). Discontinuation of anticoagulation therapy was more frequent in patients with upper extremities DVT (63.8% and 29.8% at 1-year, P<0.001). The cumulative 3-year incidence of recurrent VTE was not different between the 2 groups (9.8% and 7.4%, P=0.43) (Figure). After adjusting confounders, the risks of upper extremities DVT relative to lower extremities DVT for recurrent VTE remained insignificant (HR 0.94, 95% CI 0.36–2.01, P=0.89). Kaplan-Meier event curves for recurrence Conclusions The prevalence of patients with DVT in upper extremities was 3.0% in the current large-scale real-world registry. Patients with DVT in upper extremities more often had active cancer at diagnosis and central venous catheter use as a transient risk factor for VTE, and less often had concomitant PE. Patients with DVT in upper extremities had similar long-term risk for recurrent VTE as those with DVT in lower extremities despite shorter duration of anticoagulation. Acknowledgement/Funding Research Institute for Production Development, Mitsubishi Tanabe Pharma Corporation

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