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Oral anticoagulants (NOAC and VKA) in chronic thromboembolic pulmonary hypertension

Marc Humbert1, Gérald Simonneau1, David Pittrow2

  • 1Université Paris-Saclay, Inserm U999, Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France.

The Journal of Heart and Lung Transplantation : the Official Publication of the International Society for Heart Transplantation
|March 20, 2022
PubMed

Insights

This study compared anticoagulants in chronic thromboembolic pulmonary hypertension (CTEPH) patients. While hemorrhagic events were similar, embolic/thrombotic events were higher with non-vitamin K antagonist oral anticoagulants (NOACs) versus vitamin K antagonists (VKAs).

Area of Science:

  • Cardiology
  • Pulmonology
  • Pharmacology

Background:

  • Pulmonary hypertension poses significant risks.
  • Chronic thromboembolic pulmonary hypertension (CTEPH) requires effective anticoagulation.
  • Riociguat is a treatment option for pulmonary hypertension.

Purpose of the Study:

  • To compare adverse events (AEs) and serious AEs (SAEs) in CTEPH patients on different anticoagulants.
  • To evaluate hemorrhagic and embolic/thrombotic event rates based on anticoagulant type.
  • To assess long-term anticoagulation effects in CTEPH.

Main Methods:

  • Prospective, uncontrolled, non-interventional cohort study (EXPERT).
  • Follow-up of 1-4 years in patients with CTEPH.
  • Comparison of patients receiving vitamin K antagonists (VKAs) versus non-vitamin K antagonist oral anticoagulants (NOACs).

Main Results:

  • Overall AEs and SAEs were reported in 64.1% and 37.6% of VKA patients, versus 68.2% and 37.4% of NOAC patients.
  • Exposure-adjusted hemorrhagic event rates were similar between VKA and NOAC groups.
  • Exposure-adjusted embolic/thrombotic event rates were higher in the NOAC group, though event numbers were small.

Conclusions:

  • Anticoagulation strategies in CTEPH patients show comparable hemorrhagic event rates between VKA and NOACs.
  • Higher embolic/thrombotic event rates observed in the NOAC group warrant further investigation.
  • Additional research is needed to fully understand long-term anticoagulation effects in CTEPH.

Keywords:
chronic thromboembolic pulmonary hypertensiondrug safetynon-vitamin K antagonist oral anticoagulantsriociguatvitamin K antagonists

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