Safety and Outcomes with Direct Oral Anticoagulants Versus Vitamin-K Antagonists in Chronic Thromboembolic Pulmonary...

Area of Science:

• Cardiology
• Pulmonary Medicine
• Pharmacology

Background:

• Chronic thromboembolic pulmonary hypertension (CTEPH) is a serious condition resulting from unresolved pulmonary emboli, leading to elevated pulmonary artery pressure.
• Lifelong anticoagulation is a cornerstone of CTEPH management, with traditional use of vitamin-K antagonists (VKAs) and emerging use of direct oral anticoagulants (DOACs).
• Existing literature comparing DOACs and VKAs in CTEPH presents conflicting findings, necessitating a comprehensive analysis.

Purpose of the Study:

• To systematically compare the safety and efficacy of direct oral anticoagulants (DOACs) versus vitamin-K antagonists (VKAs) in patients with chronic thromboembolic pulmonary hypertension (CTEPH).
• To evaluate key clinical outcomes including all-cause mortality, venous thromboembolism recurrence, and bleeding events.

Main Methods:

• A systematic electronic search of major bibliographic databases was conducted to identify relevant comparative studies.
• Ten studies involving 3936 patients (1269 on DOACs, 2667 on VKAs) were included in the meta-analysis.
• Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model to assess dichotomous outcomes.

Main Results:

• DOAC treatment showed no statistically significant difference compared to VKA treatment for all-cause mortality (OR, 0.78; 95% CI, 0.35-1.71; P = 0.53).
• There were no significant differences in the risk of venous thromboembolism (OR, 1.19; 95% CI, 0.59-2.40; P = 0.63), major bleeding (OR, 0.68; 95% CI, 0.38-1.22; P = 0.20), or clinically relevant nonmajor bleeding (OR, 1.22; 95% CI, 0.80-1.86; P = 0.37).
• The analysis concluded that DOACs are noninferior to VKAs in the safety and outcomes profile for CTEPH management.

Conclusions:

• Direct oral anticoagulants (DOACs) represent a safe and effective alternative to vitamin-K antagonists (VKAs) for anticoagulation in CTEPH.
• Further research and clinical trials are warranted to provide more robust evidence and explore additional outcomes.
• The findings support the consideration of DOACs in the anticoagulation strategy for CTEPH patients.