著者

Yugo Yamashita Toshiki Fukasawa Chikashi Takeda Masato Takeuchi Koh Ono Koji Kawakami

出版者

The Japanese Circulation Society

雑誌

Circulation Journal (ISSN:13469843)

巻号頁・発行日

pp.CJ-23-0818, (Released:2023-12-23)

参考文献数

34

被引用文献数

1

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Background: The effectiveness and safety of edoxaban for venous thromboembolism (VTE) in unselected real-world patients have not been fully evaluated.Methods and Results: In the Japanese nationwide administrative database, we identified 6,262 VTE patients in whom edoxaban was initiated; these patients were divided into 3 groups based on their index doses: 15 mg/day (n=235), 30 mg/day (n=4,532), and 60 mg/day (n=1,495). We evaluated patient characteristics, recurrent VTEs, and a composite endpoint of intracranial hemorrhage (ICH) and gastrointestinal (GI) bleeding. Patient characteristics among the 15-, 30-, and 60-mg edoxaban groups varied widely regarding several aspects, including age (mean 81.0, 76.2, and 65.0 years, respectively) and body weight (mean 49.5, 51.8, and 70.3 kg, respectively). At 180 days, the cumulative incidence of recurrent VTEs in the 15-, 30-, and 60-mg edoxaban groups was 4.4%, 2.6%, and 1.8%, respectively, whereas that of ICH or GI bleeding was 7.3%, 5.4%, and 3.3%, respectively. Subgroup analyses showed that the cumulative incidence of ICH or GI bleeding in patients in the 15-mg edoxaban group was 3.6% for patients aged ≥80 years, 8.4% for those with a body weight <60 kg, and 31.3% for those with renal dysfunction.Conclusions: Only a minority of patients with VTEs received a super low dose (15 mg) of edoxaban, and these patients may be at higher risk of bleeding as well as VTE recurrence.

著者

Aki Kuwauchi Satomi Yoshida Chikashi Takeda Yugo Yamashita Takeshi Kimura Masato Takeuchi Koji Kawakami

出版者

Japan Epidemiological Association

雑誌

Journal of Epidemiology (ISSN:09175040)

巻号頁・発行日

pp.JE20220360, (Released:2023-04-22)

参考文献数

27

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BackgroundAcute pulmonary embolism (PE) is a life-threatening in-hospital complication. Recently, several studies have reported the clinical characteristics of PE among Japanese patients using the diagnostic procedure combination (DPC)/per diem payment system database. However, the validity of PE identification algorithms for Japanese administrative data is not yet clear. The purpose of this study was to evaluate the validity of using DPC data to identify acute PE inpatients.MethodsThe reference standard was symptomatic/asymptomatic PE patients included in the COntemporary ManageMent AND outcomes in patients with Venous ThromboEmbolism (COMMAND VTE) registry, which is a cohort study of acute symptomatic venous thromboembolism (VTE) patients in Japan. The validation cohort included all patients discharged from the 6 hospitals included in both the registry and DPC database. The identification algorithms comprised diagnosis, anticoagulation therapy, thrombolysis therapy, and inferior vena cava filter placement. Each algorithm’s sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were estimated.ResultsA total of 43.4% of the validation cohort was female, with a mean age of 67.3 years. The diagnosis-based algorithm showed a sensitivity of 90.2% (222/246, 95% CI; 85.8–93.6), a specificity of 99.8% (228,485/229,027, 95% CI; 99.7–99.8), a PPV of 29.1% (222/764, 95% CI; 25.9–32.4) and an NPV of 99.9% (228,485/229,509, 95% CI; 99.9–99.9) for identifying symptomatic/asymptomatic PE. Additionally, 94.6% (159/168, 95% CI; 90.1–97.5) of symptomatic PE patients were identified by the diagnosis-based algorithm.ConclusionsThe diagnosis-based algorithm may be a relatively sensitive method for identifying acute PE inpatients in the Japanese DPC database.

著者

Satomi YOSHIDA Masato TAKEUCHI Sachiko TANAKA-MIZUNO Kayoko MIZUNO Masayuki NAKASHIMA Toshiki FUKASAWA Koji KAWAKAMI

出版者

The Japan Academy

雑誌

Proceedings of the Japan Academy, Series B (ISSN:03862208)

巻号頁・発行日

vol.98, no.10, pp.517-528, 2022-12-09 (Released:2022-12-09)

参考文献数

104

被引用文献数

7

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Hospital-based registry data, including patients’ information collected by academic societies or government based research groups, were previously used for clinical research in Japan. Now, real-world data routinely obtained in healthcare settings are being used in clinical epidemiology and pharmacoepidemiology. Real-world data include a database of claims originating from health insurance associations for reimbursement of medical fees, diagnosis procedure combinations databases for acute inpatient care in hospitals, a drug prescription database, and electronic medical records, including patients’ medical information obtained by doctors, derived from electronic records of hospitals. In the past ten years, much evidence of clinical epidemiology and pharmacoepidemiology studies using real-world data has been accumulated. The purpose of this review was to introduce clinical epidemiology and pharmacoepidemiology approaches and studies using real-world data in Japan.

著者

Tomotsugu Seki Masato Takeuchi Shin Kawasoe Kazufumi Takeuchi Ryusuke Miki Kenji Ueshima Koji Kawakami

出版者

Society for Clinical Epidemiology

雑誌

Annals of Clinical Epidemiology (ISSN:24344338)

巻号頁・発行日

vol.3, no.1, pp.10-26, 2021 (Released:2021-01-07)

参考文献数

32

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BACKGROUNDSurvival benefit of outpatient cardiac rehabilitation (CR) after acute myocardial infarction (AMI) has recently been contested under the current real-world clinical practice. We investigated whether outpatient CR was associated with lower mortality and morbidity risks among Japanese AMI patients.METHODSWe analyzed patients who were admitted for AMI and received both percutaneous coronary intervention and inpatient CR from January 2011 to December 2014, using a nationwide administrative database in Japan (final date of follow-up: July 31, 2016). We compared patients who received outpatient CR and who did not, and the primary outcome was a composite of all-cause death and recurrence of AMI after the landmark time-point of day 180 after discharge. We applied Cox proportional hazards model to estimate outcomes, and propensity-score matching was applied to adjust for baseline imbalances.RESULTSA total of 5,654 patients (mean [SD] age, 66.8 [12.4] years; 21.2% female; median follow-up period [IQR] 1.44 [0.87, 2.27] years), 730 (12.9%) participated in outpatient CR at least once within 180 days of discharge. Of 1,458 propensity-score matched patients, outpatient CR participation was associated with lower but statistically non-significant risks among the primary outcome (1.38 vs. 2.12 per 100 patient-years; HR = 0.71; 95%CI, 0.32 to 1.61).CONCLUSIONSAmong Japanese patients who admitted for AMI and received both percutaneous coronary intervention and inpatient CR, outpatient CR was underutilized, and associated with a statistically non-significant mortality and morbidity benefits. Further study is necessary to reaffirm the real-world effectiveness of outpatient CR under the current real-world clinical practice.

著者

Masato TAKEUCHI

出版者

The Imaging Society of Japan

雑誌

日本画像学会誌 (ISSN:13444425)

巻号頁・発行日

vol.58, no.6, pp.633-643, 2019-12-10 (Released:2019-12-10)

参考文献数

38

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The near infrared (NIR) spectroscopy has been applied to analyze the catalyst and adsorbent surfaces. Since H2O molecules were hardly stabilized on the SiO2 surface, the hydrogen bond networks of H2O cluster on the SiO2 surfaces was almost similar to liquid phase H2O. In contrast, H2O molecules were largely stabilized on the TiO2 or Al2O3 surfaces. Thus, the H2O clusters on the TiO2 or Al2O3 surfaces had more complicated hydrogen bond networks as compared to liquid phase H2O. We have further discussed the correlation between the hydrophilic/hydrophobic properties and the surface wettability. Then, the NIR measurements for the SiO2 and cellulose adsorbents grafted with organic functional groups clearly showed the typical absorption bands due to NH2, CH3, and CH2 groups. The alkyl or aminopropyl grafted SiO2 adsorbed drastically smaller amounts of H2O molecules as compared to the pristine SiO2. While the alkyl grafted cellulose showed still hydrophilic surface character because the pristine cellulose was highly hydrophilic. Finally, the NIR spectroscopy enabled the simultaneous analyses of NH3, NH4+ and H2O adsorbed on zeolite surfaces.