P252Sex differences in the clinical characteristics and outcomes of patients with venous thromboembolism: from the COMMAND VTE Registry

Background: Venous thromboembolism (VTE) has a long-term risk of recurrence. Depending on risks of recurrence, a specific duration of anticoagulation therapy for the prevention of recurrence is recommended. However, it remains controversial whether sex is a risk of recurrent VTE. Purpose: We sought to evaluate clinical characteristics and outcomes in patients with VTE between male and female in a large observational study in Japan. Methods: The COMMAND VTE Registry is a multicenter registry enrolling consecutive patients with acute symptomatic VTE objectively confirmed by imaging examination or by autopsy among 29 centers in Japan between January 2010 and August 2014. After screening consecutive 19634 patients through hospital chart review by the physicians at each participating institution, a total of 3027 patients were enrolled in the registry. We divided the entire cohort into the male and female groups. We compared the clinical characteristics and outcomes between the 2 groups. Result: Male patients accounted for 1169 (39%) and female patients 1858 (61%). The male group was significantly younger than the female group (male 64.9±14.7 years vs. female 68.6±15.6 years, P<0.001). The male group included a higher proportion of those with prior VTE and chronic kidney disease than the female group (7.2% vs. 5.1%, P=0.02; 21% vs. 18%, P=0.02, respectively), whereas the female group included a higher proportion of those with connective tissue disease and a transient risk factor for VTE than the male group (6.1% vs. 9.3%, P=0.001; 30% vs. 40%, P<0.001, respectively). The proportion of active cancer was comparable between the 2 groups (24% vs. 22%, P=0.26), and those of pulmonary embolism and deep vein thrombosis were also similar between the 2 groups (56% vs 57%, P=0.48; 44% vs 43%, P=0.48, respectively). The male group received thrombolytic therapy in the acute phase and concomitant antiplatelet therapy as hospital discharge more frequently (19% vs. 16%, P=0.04; 13% vs. 8.4%, P<0.001). During the follow-up period, anticoagulation therapy was continued longer in the male group than in the female group (on-anticoagulation status, 91.4% vs. 90.5% at 90 days; 72.8% vs. 67.9% at 1 year; 55.4% vs. 48.5% at 5 year, log-rank P=0.006). The cumulative 5-year incidences of recurrent VTE, major bleeding, and all-cause death were not significantly different between the 2 groups (10.7% vs. 10.5%, log-rank P=0.47; 13.5% vs. 11.2%, log-rank P=0.25; 31.2% vs. 28.3%, log-rank P=0.35, respectively). Even after adjusting for potential confounders, the risk of the male group relative to the female group for recurrent VTE was not significant (Hazard ratio 0.83 [95% confidence interval 0.63–1.09], P=0.17).