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Warfarin Use Is Associated with Increased Mortality at One Year in Patients with Idiopathic Pulmonary Fibrosis
Syeda Fatima Naqvi1, Amir Humza Sohail2, Dhairya A Lakhani3
1Section of Pulmonary and Critical Care Medicine, Department of Medicine, West Virginia University, USA.
Insights
Warfarin use in idiopathic pulmonary fibrosis (IPF) patients was linked to higher mortality and hospitalization for exacerbations compared to direct oral anticoagulants (DOACs). Further research is needed to confirm these findings for IPF anticoagulation strategies.
Area of Science:
- Pulmonary Medicine
- Cardiology
- Pharmacology
Background:
- Idiopathic pulmonary fibrosis (IPF) is a progressive lung disease with limited treatment options.
- Anticoagulation is often necessary in IPF patients for cardiac or thromboembolic conditions.
- Warfarin and direct oral anticoagulants (DOACs) are commonly used anticoagulation agents.
Purpose of the Study:
- To compare the safety and efficacy of warfarin versus DOACs in patients with IPF.
- To assess the association between anticoagulation choice and patient outcomes in IPF.
Main Methods:
- Retrospective cohort study of IPF patients prescribed warfarin or DOACs.
- Univariate and multivariable logistic regression analyses were employed.
- Outcomes assessed included mortality and hospitalization for exacerbations.
Main Results:
- A total of 73 patients were analyzed (28 warfarin, 45 DOACs).
- Warfarin group showed significantly higher one-year mortality (7/28 vs. 3/45, p=0.027).
- Warfarin group had more hospitalizations for exacerbations (9/28 vs. 5/45, p=0.026).
- Warfarin independently associated with increased one-year mortality (OR: 77.4, p=0.007).
Conclusions:
- Warfarin anticoagulation is associated with significantly higher mortality in IPF patients compared to DOACs.
- DOACs may represent a safer alternative for anticoagulation in IPF.
- Larger prospective studies are required to validate these findings.
Objectives:
We studied the safety and efficacy of warfarin compared to direct acting oral anticoagulant use in patients with IPF.
Methods:
We conducted a retrospective cohort study of all patients with IPF who were prescribed warfarin or direct acting oral anticoagulants (DOACs) for cardiac or thromboembolic indications and followed at our institute for their care. Univariate tests and multivariable logistic regression analyses were used for assessing association of variables with outcomes.
Results:
A total of 73 patients were included in the study with 28 and 45 patients in the warfarin and DOAC groups, respectively. Univariable analysis revealed a significant difference in mortality in one year between warfarin and DOAC groups (7/28 vs. 3/45, p value 0.027). Significantly more patients in the warfarin group suffered an exacerbation that required hospitalization within one year (9/28 vs. 5/45, p value 0.026). Multivariate logistic regression analysis showed that anticoagulation with warfarin was independently associated with mortality at one-year follow-up (OR: 77.4, 95% CI: 5.94-409.3, p value: 0.007).
Conclusion:
In our study of patients with IPF requiring anticoagulants, we noted statistically significant higher mortality with warfarin anticoagulation when compared to DOAC use. Further larger prospective studies are needed to confirm these findings.
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