Related Experiment Video
Updated: Nov 9, 2025
Chronic Thromboembolic Pulmonary Hypertension and Assessment of Right Ventricular Function in the Piglet
Published on: November 4, 2015
Direct oral anticoagulants in chronic thromboembolic pulmonary hypertension
Mateo Porres-Aguilar1,2, Marius M Hoeper3, Belinda N Rivera-Lebron4
1Division of Hospital Medicine, Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA. mporres1980@gmail.com.
Insights
Chronic thromboembolic pulmonary hypertension (CTEPH) requires lifelong anticoagulation. While vitamin K antagonists were standard, direct oral anticoagulants (DOACs) are increasingly used, though their safety and efficacy in CTEPH need further research.
Area of Science:
- Cardiology
- Pulmonary Medicine
- Hematology
Background:
- Chronic thromboembolic pulmonary hypertension (CTEPH) is a severe outcome of acute pulmonary embolism.
- Current guidelines recommend indefinite anticoagulation for CTEPH patients.
- Vitamin K antagonists have been the historical standard of care.
Purpose of the Study:
- To discuss the rationale for oral anticoagulation in CTEPH.
- To address the controversies and issues surrounding direct oral anticoagulant (DOAC) use in CTEPH.
- To propose a strategy for future clinical research on oral anticoagulation in CTEPH.
Main Methods:
- Literature review and expert discussion.
- Analysis of current practice guidelines and emerging data.
- Identification of research gaps and future directions.
Main Results:
- A shift from vitamin K antagonists to DOACs is observed in CTEPH management.
- There is a lack of robust data on DOAC safety and efficacy in this specific patient population.
- Key issues include appropriate patient selection, monitoring, and long-term outcomes.
Conclusions:
- Oral anticoagulation is crucial for managing CTEPH.
- Further clinical research is essential to establish the role and optimal use of DOACs in CTEPH.
- Evidence-based strategies are needed to guide the transition to and use of DOACs in CTEPH patients.
Abstract:
Chronic thromboembolic pulmonary hypertension (CTEPH) represents the later stage consequence of at least one or more unresolved episodes of acute pulmonary embolism; thus, indefinite anticoagulation is strongly recommended by current practice guidelines. Historically, vitamin K antagonists have been widely used in these patients. However, recent data indicate a shift toward direct oral anticoagulants (DOACs), despite lack of data on the safety and efficacy in this patient population. Herein, we briefly discuss the current rationale for oral anticoagulation use in CTEPH, addressing important issues and controversies involved with the use of DOACs, opening a strategy for further clinical research in the field of oral anticoagulation.
Related Concept Videos
01:29Venous Thrombosis III: Interprofessional Care
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:23Treatment for Pulmonary Arterial Hypertension: Prostacyclin Receptor Agonists
These agonists bind to the IPR receptor situated on the plasma membrane of the pulmonary artery smooth muscle cells. This binding triggers a cascade of reactions known as the GS-AC-cAMP-PKA pathway. This pathway results in the relaxation of smooth muscle...
01:26Treatment for Pulmonary Arterial Hypertension: Receptor Tyrosine Kinase Inhibitors and Calcium Channel Blockers
TKIs, such as imatinib (Gleevec), are particularly effective in tackling the growth and mitogenic factors that become upregulated in PAH patients. These factors contribute to the...
01:28Treatment for Pulmonary Arterial Hypertension: Phosphodiesterase Inhibitors
Among the PDE5 inhibitors, sildenafil (Revatio) stands out as a competitive and selective inhibitor. It operates by elevating cellular levels of cGMP and augmenting signaling through the cGMP-PKG pathway, promoting vasodilation. Upon oral...