Impact on survival of warfarin in patients with pulmonary arterial hypertension receiving subcutaneous treprostinil. Issue 5 (14th September 2017)

• Record Type: Journal Article
• Authors: Ascha, Mona; Zhou, Xuan; Rao, Youlan; Minai, Omar A.; Tonelli, Adriano R.
• Is Part Of: Cardiovascular therapeutics. Volume 35:Issue 5(2017)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2017-09-14
• Subjects: Anticoagulation -- Pulmonary arterial hypertension -- Survival -- Treprostinil -- Warfarin; Cardiovascular pharmacology -- Periodicals; Cardiovascular agents -- Periodicals; Cardiovascular system -- Diseases -- Chemotherapy -- Periodicals; Cardiovascular Agents -- Periodicals; Cardiovascular Diseases -- drug therapy -- Periodicals; Agents cardiovasculaires -- Périodiques; Appareil cardiovasculaire -- Maladies -- Chimiothérapie -- Périodiques; 616.1005
• DOI: 10.1111/1755-5922.12281
• Languages: English
• ISSNs: 1755-5914

Abstract

Summary: Introduction: Anticoagulation is a common treatment modality in patients with pulmonary arterial hypertension (PAH). Further studies are needed to appropriately assess the risk/benefit ratio of anticoagulation, particularly in PAH patients receiving PAH‐specific therapies. Aims: We use observational long‐term data on PAH patients treated with subcutaneous (SQ) treprostinil from a large open‐label study. Patients were followed for up to 4 years. The use of warfarin and bleeding events were recorded. Results: At total of 860 patients (age [mean±SD] 46±15 years, 76% female, 83% Caucasian, 49% idiopathic PAH, and 76% New York Heart Association [NYHA] functional class III) were included. All patients received SQ treprostinil (15% also other pulmonary hypertension [PH]‐therapies) and 590 (69%) received warfarin during the study. The proportions of women, African American, and idiopathic pulmonary hypertension (IPAH) patients were higher in the group receiving warfarin. A higher proportion of patients with congenital heart disease and portopulmonary hypertension did not receive warfarin. There were no differences in unadjusted long‐term survival between PAH patients receiving warfarin or not (log‐rank test, P value=.69), even when only considering idiopathic PAH ( P =.32). In addition, no difference was found in adjusted long‐term survival both in PAH ( P =.84) and idiopathic PAH patients ( P =.44) based on the use of warfarin. Furthermore, no survival difference based on the use of warfarin were noted between propensity score‐matched PAH patients ( P =.37). Conclusions: Long‐term anticoagulation with warfarin was not associated with any significant effect on survival in PAH or idiopathic PAH patients treated with SQ treprostinil.