ORIGINAL ARTICLE
A multicenter study of anticoagulation in operable chronic thromboembolic pulmonary hypertension

https://doi.org/10.1111/jth.14649Get rights and content
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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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Manuscript Handled by: Sabine Eichinger

Final decision: Sabine Eichinger, 23 September 2019