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Anticoagulation in Pulmonary Arterial Hypertension: Do We Know the Answer?
Himanshu Rawal1, Annya Suman2, Rahul R Bhoite2
1Department of Pulmonary, Critical Care, Allergy and Immunology, Wake Forest Baptist Health, Winston-Salem, NC.
Pulmonary arterial hypertension (PAH) involves thrombosis, making anticoagulation a potential treatment. Current guidelines recommend anticoagulation for PAH, but evidence is limited, necessitating further research.
Area of Science:
- Cardiovascular Medicine
- Pulmonary Hypertension
- Hematology
Background:
- Pulmonary arterial hypertension (PAH) involves endothelial dysfunction, smooth muscle proliferation, and thrombosis.
- Targeting thrombotic pathways is a strategy to slow PAH progression and improve survival.
- Anticoagulation use has increased, correlating with improved PAH patient survival.
Purpose of the Study:
- To review the pathophysiology of thrombosis in PAH.
- To examine the rationale for using anticoagulation in PAH.
- To analyze current literature on anticoagulation's role in PAH.
Main Methods:
- Literature review of pathophysiology, rationale, and existing studies.
- Analysis of current evidence supporting anticoagulation in PAH.
- Examination of guideline recommendations for anticoagulation in PAH.
Main Results:
- Observational studies supporting anticoagulation in PAH are limited and carry a high risk of bias.
- Warfarin has been the primary anticoagulant studied in PAH.
- Guidelines recommend anticoagulation (Grade II) despite weak evidence.
Conclusions:
- Anticoagulation is a proposed mechanism to slow PAH progression.
- Current guideline recommendations for anticoagulation in PAH are based on limited, biased studies.
- Further research is needed to clarify the role and optimal use of anticoagulation in PAH.
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