Abstract 12091: Actual Management of Venous Thromboembolism Complicated by Antiphospholipid Antibody Syndrome in Japan. From the Command VTE Registry-2

Background: Venous thromboembolism (VTE) complicated with antiphospholipid antibody syndrome (APS) requires long-term anticoagulation to prevent the recurrent thrombosis. Direct oral anticoagulants (DOACs) have been widely used for VTE, but the guideline recommendations for their use are less favorable for APS-complicated VTE. There are no reports on the actual practice of APS complicated VTE in Japan in the DOAC era. So we investigated the actual practice and prognosis in APS-associated VTE, particulary with regard to the use of DOACs.

Methods: COMMAND VTE Registry-2 is a multicenter registry enrolling 5,197 consecutive acute symptomatic VTE patients among 31 centers in Japan between January 2015 and August 2020. In this cohort, we examined the differences in actual VTE practice between patients with and without APS.

Results: The current study population consisted of 83 APS-complicated VTE (mean age, 55; 53 male patients [63.9%]), and 5,114 VTE patients without APS (mean age, 68; 3010 male patients [58.9%]). Compared with patients without (w/o) APS, those with (w/) APS were more likely to have proximal deep vein thrombosis (DVT) than distal DVT, but the rate of pulmonary embolism was comparable. There was no difference in the rate DOAC use between patients w/[74.7%] and w/oAPS [79.5%]. All-cause mortality was significantly lower in the APS group (w/APS 6 [7.2%]; w/oAPS 1317 [25.8%]), VTE recurrence rates were similar (w/APS 8 [9.6%]; w/oAPS 275 [5.4%]), and the interval to VTE recurrence was significantly longer in the APS group (median: w/APS, 1050 days; w/oAPS 724 days). Major bleeding event rate was comparable (w/APS 8 [9.6%]; w/oAPS 462 [9.0%]).

Conclusions: DOACs were used equally in long-term anticoagulation of VTE complicated with APS compared with VTE without APS, with better outcome.