Utility of the modified Ottawa score for identification of more preferable candidates of extended anticoagulation therapy in cancer-associated isolated distal deep vein thrombosis: insight from the ONCO DVT Study.

IF 5.5 2区医学 Q1 HEMATOLOGY Journal of Thrombosis and Haemostasis Pub Date : 2024-09-14 DOI:10.1016/j.jtha.2024.09.003

Wei Xiong, Yugo Yamashita, Takeshi Morimoto, Nao Muraoka, Michihisa Umetsu, Yuji Nishimoto, Takuma Takada, Yoshito Ogihara, Tatsuya Nishikawa, Nobutaka Ikeda, Kazunori Otsui, Daisuke Sueta, Yukari Tsubata, Masaaki Shoji, Ayumi Shikama, Yutaka Hosoi, Yasuhiro Tanabe, Ryuki Chatani, Kengo Tsukahara, Naohiko Nakanishi, Kitae Kim, Satoshi Ikeda, Koh Ono, Takeshi Kimura

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Abstract

Background: The ONCO DVT study (Edoxaban for 12 Months Versus 3 Months in Patients With Cancer With Isolated Distal Deep Vein Thrombosis) revealed superiority of 12-month relative to 3-month edoxaban treatment for the thrombotic risk in cancer-associated isolated distal deep vein thrombosis. However, it is unknown whether the superiority could be common in different modified Ottawa score subgroups.

Objectives: To identify more preferable candidates for extended anticoagulation in patients with cancer-associated isolated distal deep vein thrombosis using the modified Ottawa score.

Methods: In this post-hoc subgroup analysis of the ONCO DVT study, we stratified 601 patients into the low (≤-1, N = 126), intermediate (0, N = 323), and high (≥1, N = 152) modified Ottawa score subgroups and compared clinical outcomes between the 12-month and 3-month edoxaban treatment groups.

Results: The cumulative incidence of symptomatic recurrent venous thromboembolism or venous thromboembolism-related death was not different between the 12-month and 3-month edoxaban treatment groups in the low score subgroup (0.0% vs 2.2%), whereas it was lower in the 12-month than in the 3-month edoxaban treatment group in the intermediate (0.8% vs 7.6%) and high (3.1% vs 15.6%) score subgroups. There were no significant differences in the cumulative incidences of the major bleeding between the 12-month and 3-month edoxaban treatment groups in the low (10.1% vs 7.6%), intermediate (8.8% vs 5.0%), and high (13.9% vs 12.6%) score subgroups.

Conclusion: A 12-month compared with 3-month edoxaban treatment showed a lower risk of thrombotic events in patients with cancer-associated isolated distal deep vein thrombosis in the intermediate and high modified Ottawa score subgroups but not in the low score subgroup, suggesting a limited benefit of extended anticoagulation therapy beyond 3 months in patients with low modified Ottawa score.

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改良渥太华评分在癌症相关孤立性远端深静脉血栓形成中识别更佳延长抗凝治疗候选者的实用性：ONCO 深静脉血栓形成研究的启示。

研究背景ONCO DVT研究显示，在癌症相关孤立远端深静脉血栓（DVT）的血栓风险方面，12个月的依多沙班治疗优于3个月的依多沙班治疗。然而，这种优越性在不同的改良渥太华评分亚组中是否具有共性尚不得而知：在这项 ONCO DVT 研究的事后亚组分析中，我们将 601 例患者分为低（≤-1，N=126）、中（0，N=323）和高（≥1，N=152）改良渥太华评分亚组，并比较了 12 个月和 3 个月依多沙班治疗组的临床结果：在低分亚组中，12个月和3个月依多沙班治疗组的无症状复发性静脉血栓栓塞症（VTE）或VTE相关死亡的累积发生率没有差异（0.0% vs. 2.2%），而在中分（0.8% vs. 7.6%）和高分（3.1% vs. 15.6%）亚组中，12个月依多沙班治疗组的发生率低于3个月依多沙班治疗组。在低分（10.1% vs. 7.6%）、中分（8.8% vs. 5.0%）和高分（13.9% vs. 12.6%）亚组中，埃多沙班治疗12个月组和3个月组的大出血累计发生率无明显差异：为期12个月的依多沙班治疗与为期3个月的依多沙班治疗相比，在中度和高度修改后渥太华评分亚组中，癌症相关孤立性远端深静脉血栓患者发生血栓事件的风险较低，但在低评分亚组中风险不高，这表明在低修改后渥太华评分患者中，延长抗凝治疗3个月以上的获益有限。

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来源期刊

Journal of Thrombosis and Haemostasis 医学-外周血管病

CiteScore

24.30

自引率

3.80%

发文量

321

审稿时长

1 months

期刊介绍： The Journal of Thrombosis and Haemostasis (JTH) serves as the official journal of the International Society on Thrombosis and Haemostasis. It is dedicated to advancing science related to thrombosis, bleeding disorders, and vascular biology through the dissemination and exchange of information and ideas within the global research community. Types of Publications: The journal publishes a variety of content, including: Original research reports State-of-the-art reviews Brief reports Case reports Invited commentaries on publications in the Journal Forum articles Correspondence Announcements Scope of Contributions: Editors invite contributions from both fundamental and clinical domains. These include: Basic manuscripts on blood coagulation and fibrinolysis Studies on proteins and reactions related to thrombosis and haemostasis Research on blood platelets and their interactions with other biological systems, such as the vessel wall, blood cells, and invading organisms Clinical manuscripts covering various topics including venous thrombosis, arterial disease, hemophilia, bleeding disorders, and platelet diseases Clinical manuscripts may encompass etiology, diagnostics, prognosis, prevention, and treatment strategies.