Takahiro Kuno, Norimichi Koitabashi, Yugo Yamashita, Takeshi Morimoto, Yoshiaki Ohyama, Noriaki Takama, Masaru Obokata, Ryuki Chatani, Kazuhisa Kaneda, Yuji Nishimoto, Nobutaka Ikeda, Yohei Kobayashi, Satoshi Ikeda, Kitae Kim, Toru Takase, Shuhei Tsuji, Maki Oi, Takuma Takada, Kazunori Otsui, Jiro Sakamoto, Yoshito Ogihara, Takeshi Inoue, Shunsuke Usami, Po-Min Chen, Kiyonori Togi, Seiichi Hiramori, Kosuke Doi, Hiroshi Mabuchi, Yoshiaki Tsuyuki, Koichiro Murata, Kensuke Takabayashi, Hisato Nakai, Daisuke Sueta, Wataru Shioyama, Tomohiro Dohke, Ryusuke Nishikawa, Hideki Ishii, Takeshi Kimura, COMMAND VTE Registry-2 Investigators
VTE patients diagnosed on weekends presented more often with PE and with greater severity. Although the higher crude 30-day mortality in weekend PE patients was attenuated after adjustment, a weekend diagnosis remained associated with higher 30-day major bleeding risk.
BACKGROUND: Data on the association of weekend vs. weekday diagnosis with clinical outcomes of venous thromboembolism (VTE) in the direct oral anticoagulant (DOAC) era are limited.
METHODS AND RESULTS: The COMMAND VTE Registry-2 is a multicenter registry that enrolled 5,197 consecutive acute symptomatic VTE patients from 31 centers in Japan between January 2015 and August 2020. Baseline characteristics, anticoagulation strategies, and 30-day outcomes were compared between patients diagnosed on weekends (n=537; 10.3%) and those diagnosed on weekdays (n=4,660, 89.7%). Compared with patients diagnosed on weekdays, those diagnosed on weekends more frequently presented with pulmonary embolism (PE; 74.7% vs. 51.2%; P<0.001) and more often received thrombolysis and cardiopulmonary support. The cumulative 30-day incidence of all-cause death in PE patients was significantly higher in patients diagnosed on weekends than in those diagnosed on weekdays (7.5% vs. 4.1%; P=0.003), but the difference was not significant after multivariable adjustment (hazard ratio 1.51; 95% confidence interval [CI] 0.99-2.30; P=0.056). The 30-day risk of major bleeding was significantly higher in weekend PE patients after multivariable adjustment (hazard ratio 1.79; 95% CI 1.11-2.88; P=0.02).
CONCLUSIONS: VTE patients diagnosed on weekends presented more often with PE and with greater severity. Although the higher crude 30-day mortality in weekend PE patients was attenuated after adjustment, a weekend diagnosis remained associated with higher 30-day major bleeding risk.