A multicenter study of anticoagulation in operable chronic thromboembolic pulmonary hypertension. (18th October 2019)

• Record Type: Journal Article
• Authors: Bunclark, Katherine; Newnham, Michael; Chiu, Yi‐Da; Ruggiero, Alessandro; Villar, Sofia S.; Cannon, John E.; Coghlan, Gerry; Corris, Paul A.; Howard, Luke; Jenkins, David; Johnson, Martin; Kiely, David G.; Ng, Choo; Screaton, Nicholas; Sheares, Karen; Taboada, Dolores; Tsui, Steven; Wort, Stephen John; Pepke‐Zaba, Joanna; Toshner, Mark
• Is Part Of: Journal of thrombosis and haemostasis. Volume 18:Number 1(2020)
• Page Start: 114
• Page End: 122
• Publication Date: 2019-10-18
• Subjects: anticoagulant -- complications -- pulmonary hypertension -- venous thromboembolism -- warfarin; Thrombosis -- Periodicals; Hemostasis -- Periodicals; Blood coagulation disorders -- Periodicals; 616.1
• DOI: 10.1111/jth.14649
• Languages: English
• ISSNs: 1538-7933

Abstract

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.