Current Venous Thromboembolism Management and Outcomes in Japan – Nationwide The Japan Venous Thromboembolism Treatment Registry Observational Study –

Mashio Nakamura; Tetsuro Miyata; Yasushi Ozeki; Morimasa Takayama; Kimihiro Komori; Norikazu Yamada; Hideki Origasa; Hirono Satokawa; Hideaki Maeda; Nobuhiro Tanabe; Naoki Unno; Takashi Shibuya; Kazuo Tanemoto; Katsuhiro Kondo; Tetsuhito Kojima

doi:10.1253/circj.CJ-13-0886

Peripheral Vascular Disease

Current Venous Thromboembolism Management and Outcomes in Japan

– Nationwide The Japan Venous Thromboembolism Treatment Registry Observational Study –

Mashio Nakamura, Tetsuro Miyata, Yasushi Ozeki, Morimasa Takayama, Kimihiro Komori, Norikazu Yamada, Hideki Origasa, Hirono Satokawa, Hideaki Maeda, Nobuhiro Tanabe, Naoki Unno, Takashi Shibuya, Kazuo Tanemoto, Katsuhiro Kondo, Tetsuhito Kojima

Author information

Mashio Nakamura
Department of Clinical Cardiovascular Research, Graduate School of Medicine, Mie University
Tetsuro Miyata
Division of Vascular Surgery, Graduate School of Medicine, University of Tokyo
Yasushi Ozeki
Development and Medical Affairs Division, GlaxoSmithKline
Morimasa Takayama
Department of Cardiology, Sakakibara Heart Institute
Kimihiro Komori
Division of Vascular Surgery, Graduate School of Medicine, Nagoya University
Norikazu Yamada
Department of Cardiology and Nephrology, Graduate School of Medicine, Mie University
Hideki Origasa
Division of Biostatistics and Clinical Epidemiology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama
Hirono Satokawa
Department of Cardiovascular Surgery, Fukushima Medical University School of Medicine
Hideaki Maeda
Department of Cardiovascular Surgery, Nihon University School of Medicine
Nobuhiro Tanabe
Department of Respirology, Graduate School of Medicine, Chiba University
Naoki Unno
Second Department of Surgery, Hamamatsu University School of Medicine
Takashi Shibuya
Unit of Vascular Surgery, Department of Surgery, Kansai Medical University Hirakata Hospital
Kazuo Tanemoto
Department of Cardiovascular Surgery, Kawasaki Medical School
Katsuhiro Kondo
Clinic of Cardiology, Kokura Memorial Hospital
Tetsuhito Kojima
Department of Pathophysiological Laboratory Sciences, Graduate School of Medicine, Nagoya University

Keywords: Deep vein thrombosis, Epidemiology, Pulmonary embolism, Venous thromboembolism

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Supplementary material

2014 Volume 78 Issue 3 Pages 708-717

DOI https://doi.org/10.1253/circj.CJ-13-0886

Editorial (78-3 pp.597-598)

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Abstract

Background: Epidemiology and clinical management of acute venous thromboembolism (VTE) are not readily available in Japan. Methods and Results: The Japan VTE Treatment Registry (JAVA) is a multicenter cohort study of consecutive patients with an objectively confirmed, symptomatic acute pulmonary embolism (PE), symptomatic acute deep vein thrombosis (DVT), or asymptomatic acute proximal DVT. Of the 1,076 patients enrolled with acute VTE, 68.7% presented with an isolated DVT; 17.0% had PE alone; and 14.4% had both. VTE management was characterized by a high rate of inferior vena cava filter insertion (40.6%), frequent thrombolysis (21.1%), and sub-therapeutic unfractionated heparin-based anticoagulation, followed by warfarin prescription, mostly targeting an international normalized ratio of 2.0 (range, 1.5–2.5). During a mean observation period of 252.5 days, 29 recurrent cases of VTE were documented, yielding an incidence rate of 3.9 per 100 patient-years. A total of 123 patients died during the study period, corresponding to a rate of 16.6 deaths per 100 patient-years. The incidence of major bleeding was 3.2% per patient-year, including 2 fatal hemorrhages and 7 intracranial hemorrhages. Conclusions: VTE management in Japan is characterized by a highly aggressive strategy in the acute phase, in contrast to protocols that use low-level anticoagulation. The VTE recurrence rates in Japan and Western countries are similar, but mortality is higher in Japan, with significant variability depending on patient and management characteristics. (Circ J 2014; 78: 708–717)

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