Comparison of Clinical Outcomes of Venous Thromboembolism Between Weekend Diagnosis and Weekday Diagnosis in the Direct Oral Anticoagulant Era: Insights From the COMMAND VTE Registry-2.

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.