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Multicenter Study
. 2020 Jan;18(1):114-122.
doi: 10.1111/jth.14649. Epub 2019 Oct 18.

A multicenter study of anticoagulation in operable chronic thromboembolic pulmonary hypertension

Katherine Bunclark  1 , Michael Newnham  1   2 , Yi-Da Chiu  1   3 , Alessandro Ruggiero  1 , Sofia S Villar  1   3 , John E Cannon  1 , Gerry Coghlan  4 , Paul A Corris  5 , Luke Howard  6 , David Jenkins  1 , Martin Johnson  7 , David G Kiely  8 , Choo Ng  1 , Nicholas Screaton  1 , Karen Sheares  1 , Dolores Taboada  1 , Steven Tsui  1 , Stephen John Wort  9 , Joanna Pepke-Zaba  1 , Mark Toshner  1   2
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Free article
Multicenter Study

A multicenter study of anticoagulation in operable chronic thromboembolic pulmonary hypertension

Katherine Bunclark et al. J Thromb Haemost. 2020 Jan.
Free article

Abstract

Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is an uncommon complication of acute pulmonary emboli necessitating lifelong anticoagulation. Despite this, few data exist on the safety and efficacy of vitamin K antagonists (VKAs) in CTEPH and none for direct oral anticoagulants (DOACs).

Objectives: To evaluate outcomes and complication rates in CTEPH following pulmonary endarterectomy (PEA) for individuals receiving VKAs or DOACs.

Methods: Consecutive CTEPH patients undergoing PEA between 2007 and 2018 were included in a retrospective analysis. Postoperative outcomes, recurrent venous thromboembolism (VTE), and bleeding events were obtained from patient medical records.

Results: Seven hundred ninety-four individuals were treated with VKAs and 206 with DOACs following PEA. Mean observation period was 612 (standard deviation: 702) days. Significant improvements in hemodynamics and functional status were observed in both groups following PEA (P < .001). Major bleeding events were equivalent (P = 1) in those treated with VKAs (0.67%/person-year) and DOACs (0.68%/person-year). The VTE recurrence was proportionately higher (P = .008) with DOACs (4.62%/person-year) than VKAs (0.76%/person-year), although survival did not differ.

Conclusions: Post-PEA functional and hemodynamic outcomes appear unaffected by anticoagulant choice. Bleeding events were similar, but recurrent VTE rates significantly higher in those receiving DOACs. Our study provides a strong rationale for prospective registry data and/or studies to evaluate the safety of DOACs in CTEPH.

Keywords: anticoagulant; complications; pulmonary hypertension; venous thromboembolism; warfarin.

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REFERENCES

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