Venous thromboembolism in Asia and worldwide: Emerging insights from GARFIELD-VTE
ISTH Academy. Angchaisuksiri P. 07/08/19; 264308; PB1114 Topic: VTE Therapy
Pantep Angchaisuksiri
Pantep Angchaisuksiri
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PB1114

Venous Thromboembolism in Asia and Worldwide: Emerging Insights from GARFIELD-VTE

P. Angchaisuksiri1, S.-M. Bang2, H. Fryk3, C.-E. Chiang4, Z.-C. Jing5, S. Wang6, K. Kondo7, J. Sathar8, E. Tse9, S. Goto10, A. Kakkar3, on behalf of the GARFIELD-VTE Investigators
1Division of Hematology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, 2Seoul National University, Bundang Hospital Seongnam, Department of Internal Medicine, Korea, United Kingdom, 3Thrombosis Research Institute, London, United Kingdom, 4Division of Cardiology, Taipei Veterans General Hospital and National Yang-Ming University, General Clinical Research Center, Taipei, Taiwan, Republic of China, 5FuWai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College & Chinese Academy of Medical Sciences, State Key Lab of Cardiovascular Disease, Beijing, China, 6The First Affiliated Hospital of Sun Yat-sen University, Division of Vascular Surgery, Guangzhou, China, 7Kokura Memorial Hospital, Department of Cardiology, Kitakyushu, Japan, 8Ampang Hospital, Department of Haematology, Selangor, Malaysia, 9University of Hong Kong, Queen Mary Hospital, Department of Medicine, Pok Fu Lam, Hong Kong, 10Tokai University School of Medicine, Department of Medicine (Cardiology), Tokai, Japan

Main Topic: Venous Thromboembolism
Category: VTE Therapy

Background: Although the incidence of venous thromboembolism (VTE) in Asia has been reported to be lower than that of the Western world, its prevalence is increasing and has become a major health concern in several Asian countries.
Aims: Compare the baseline characteristics, treatment patterns, 12-month outcomes and cause of death in VTE patients from Asia with those from the rest of the world, enrolled in the Global Anticoagulant Registry in the FIELD (GARFIELD)-VTE.
Methods: GARFIELD-VTE (ClinicalTrials.gov: NCT02155491) is a global, prospective, non-interventional study of real-world treatment practices. 10,685 patients with objectively confirmed VTE were enrolled between May 2014 and January 2017. 1,822 (17.1%) were from Asia (China n=420, Hong Kong n=98, Japan n=148, Malaysia n=244, South Korea n=343, Taiwan n=232, Thailand n=337).
Results: 62.2% of Asian patients had deep vein thrombosis (DVT), 37.8% had pulmonary embolism ± DVT. Asian patients (vs non-Asian) were more often female (57.4% vs. 48.0%), non-smokers (74.0% vs 58.9%), older; mean age (standard deviation) 59 (16.7) years vs. 57 (17.0) years, and had a lower BMI; mean (standard deviation) 24.8 (5.0) kg/m2 vs 29.1 (6.6) kg/m2. Asian patients were more often managed in the hospital setting (86.9% vs 70.4%), and were more likely to have active cancer (19.6% vs. 7.9%) or a history of cancer (18.9 vs. 12.0%). Hospitalization (17.0%) and surgery (13.4%) were the most common provoking factors. Asian patients most frequently received a direct oral anticoagulant alone (31.4%) or parenteral therapy alone (23.3%) (Table 1). Over 12-months follow-up, rates (95% confidence intervals) of all-cause mortality, major bleed, and recurrent VTE in Asians (vs non-Asians) were: 15.0 (13.2-17.1) vs. 5.9 (5.4-6.4), 2.4 (1.7-3.3) vs. 1.7 (1.4-2.0), and 5.6 (4.5-7.0) vs. 5.1 (4.6-5.6) per 100 person-years, respectively (Table 2).
Conclusions: Asian and non-Asian patients have different risk profiles which may contribute to differences in outcomes.

Treatment Asia (N=1822) Non-Asia (N=8,863)
Parenteral therapy only 424 (23.3%) 1404 (15.9%)
Parenteral therapy + VKA 368 (20.3%) 2430 (27.5%)
VKA only 81 (4.5%) 487 (5.5%)
DOAC only 572 (31.5%) 2647 (30.0%)
Parenteral therapy + DOAC 198 (10.9%) 1581 (17.9%)
Other AC 51 (2.8%) 52 (0.6%)
No AC treatment 120 (6.6%) 234 (2.7%)
Dead/Withdrawn/ Lost to follow up 0 (0.0%) 1 (0.0%)
Missing 8 27
[Table 1: Anticoagulation treatment at baseline (± 30 days of VTE diagnosis) in Asian and non-Asian patients enrolled in GARFIELD-VTE.]



  Asia (N=1,802) Non-Asia (N=8,807)  
Event n Rate (per 100 person-years) 95% CI n Rate (per 100 person-years) 95% CI P value
All-cause mortality 227 15.0 13.2-17.1 480 5.9 5.4-6.4 <0.01
Major bleed 36 2.4 1.7-3.3 138 1.7 1.4-2.0 0.07
Recurrent VTE 82 5.6 4.5-7.0 402 5.1 4.6-5.6 0.40
Any bleeding 131 9.1 7.7-10.8 844 11.1 10.4-11.9 0.03
Cancer 25 1.7 1.1-2.5 199 2.5 2.2-2.8 0.06
Hospital admission 437 34.5 31.4-37.8 3664 65.1 63.1-67.3 <0.01
Stroke/TIA 10 0.7 0.4-1.2 62 0.8 0.6-1.0 0.68
Myocardial Infarction 12 0.8 0.5-1.4 57 0.7 0.5-0.9 0.69
[Table 2: 12 month outcomes in Asian and non-Asian patients enrolled in GARFIELD-VTE.]

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