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Anticoagulation in chronic thromboembolic pulmonary hypertension: A systematic review and meta-analysis

Yoshiko Ishisaka1, Atsuyuki Watanabe1, Hisato Takagi2

  • 1Department of Medicine, Mount Sinai Beth Israel, New York, NY, USA.

Thrombosis Research
|October 15, 2023
PubMed

Insights

Direct oral anticoagulants (DOAC) show lower mortality but increased recurrent pulmonary embolism risk in chronic thromboembolic pulmonary hypertension (CTEPH) patients compared to vitamin K antagonists (VKA). Further research is needed due to study limitations.

Area of Science:

  • Cardiology
  • Pulmonology
  • Pharmacology

Background:

  • Chronic thromboembolic pulmonary hypertension (CTEPH) necessitates lifelong anticoagulation.
  • Evidence for direct oral anticoagulants (DOACs) in CTEPH management is limited.
  • This study compares DOACs with vitamin K antagonists (VKAs) in CTEPH patients.

Approach:

  • A systematic review and meta-analysis of literature from PubMed and EMBASE up to March 2023.
  • Included one randomized clinical trial and six observational studies (2969 patients).
  • Analyzed outcomes including bleeding events, venous thromboembolism (VTE) recurrence, and mortality.

Key Points:

  • No significant differences in major or all bleeding events between DOACs and VKAs.
  • DOACs were associated with a lower risk of mortality (RR 0.54, 95% CI: 0.37-0.79).
  • A higher risk of recurrent pulmonary embolism (PE) was observed with DOACs (RR 3.80, 95% CI: [1.93-7.50]).

Conclusions:

  • DOACs may offer a survival benefit in CTEPH patients compared to VKAs.
  • However, DOACs are linked to an increased risk of recurrent PE.
  • The observational nature of most studies necessitates caution due to potential biases and confounding factors.
Abstract

Keywords:
Chronic thromboembolic pulmonary hypertensionDirect oral anticoagulantsPulmonary embolismVenous thromboembolismVitamin K antagonists

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