BACKGROUND: Chronic thromboembolic pulmonary hypertension (CTEPH) is an uncommon complication of acute pulmonary emboli necessitating lifelong anticoagulation. Despite this, few data exist on the safety and efficacy of vitamin K antagonists (VKAs) in CTEPH and none for direct oral anticoagulants (DOACs). OBJECTIVES: To evaluate outcomes and complication rates in CTEPH following pulmonary endarterectomy (PEA) for individuals receiving VKAs or DOACs. METHODS: Consecutive CTEPH patients undergoing PEA between 2007 and 2018 were included in a retrospective analysis. Postoperative outcomes, recurrent venous thromboembolism (VTE), and bleeding events were obtained from patient medical records. RESULTS: Seven hundred ninety-four individuals were treated with VKAs and 206 with DOACs following PEA. Mean observation period was 612 (standard deviation: 702) days. Significant improvements in hemodynamics and functional status were observed in both groups following PEA (P < .001). Major bleeding events were equivalent (P = 1) in those treated with VKAs (0.67%/person-year) and DOACs (0.68%/person-year). The VTE recurrence was proportionately higher (P = .008) with DOACs (4.62%/person-year) than VKAs (0.76%/person-year), although survival did not differ. CONCLUSIONS: Post-PEA functional and hemodynamic outcomes appear unaffected by anticoagulant choice. Bleeding events were similar, but recurrent VTE rates significantly higher in those receiving DOACs. Our study provides a strong rationale for prospective registry data and/or studies to evaluate the safety of DOACs in CTEPH.
BACKGROUND: Chronic thromboembolic pulmonary hypertension (CTEPH) is an uncommon complication of acute pulmonary emboli necessitating lifelong anticoagulation. Despite this, few data exist on the safety and efficacy of vitamin K antagonists (VKAs) in CTEPH and none for direct oral anticoagulants (DOACs). OBJECTIVES: To evaluate outcomes and complication rates in CTEPH following pulmonary endarterectomy (PEA) for individuals receiving VKAs or DOACs. METHODS: Consecutive CTEPH patients undergoing PEA between 2007 and 2018 were included in a retrospective analysis. Postoperative outcomes, recurrent venous thromboembolism (VTE), and bleeding events were obtained from patient medical records. RESULTS: Seven hundred ninety-four individuals were treated with VKAs and 206 with DOACs following PEA. Mean observation period was 612 (standard deviation: 702) days. Significant improvements in hemodynamics and functional status were observed in both groups following PEA (P < .001). Major bleeding events were equivalent (P = 1) in those treated with VKAs (0.67%/person-year) and DOACs (0.68%/person-year). The VTE recurrence was proportionately higher (P = .008) with DOACs (4.62%/person-year) than VKAs (0.76%/person-year), although survival did not differ. CONCLUSIONS: Post-PEA functional and hemodynamic outcomes appear unaffected by anticoagulant choice. Bleeding events were similar, but recurrent VTE rates significantly higher in those receiving DOACs. Our study provides a strong rationale for prospective registry data and/or studies to evaluate the safety of DOACs in CTEPH.
Authors: Caio Julio Cesar Dos Santos Fernandes; Jaquelina Sonoe Ota-Arakaki; Frederico Thadeu Assis Figueiredo Campos; Ricardo de Amorim Correa; Marcelo Basso Gazzana; Carlos Vianna Poyares Jardim; Fábio Biscegli Jatene; Jose Leonidas Alves Junior; Roberta Pulcheri Ramos; Daniela Tannus; Carlos Teles; Mario Terra Filho; Daniel Waetge; Rogerio Souza Journal: J Bras Pneumol Date: 2022-06-24 Impact factor: 2.800
Authors: Grzegorz Kopeć; Olga Dzikowska-Diduch; Ewa Mroczek; Tatiana Mularek-Kubzdela; Łukasz Chrzanowski; Ilona Skoczylas; Michał Tomaszewski; Małgorzata Peregud-Pogorzelska; Danuta Karasek; Ewa Lewicka; Wojciech Jacheć; Zbigniew Gąsior; Piotr Błaszczak; Katarzyna Ptaszyńska-Kopczyńska; Katarzyna Mizia-Stec; Andrzej Biederman; Dariusz Zieliński; Roman Przybylski; Piotr Kędzierski; Marcin Waligóra; Marek Roik; Marek Grabka; Joanna Orłowska; Aleksander Araszkiewicz; Marta Banaszkiewicz; Sylwia Sławek-Szmyt; Szymon Darocha; Wojciech Magoń; Alicja Dąbrowska-Kugacka; Jakub Stępniewski; Kamil Jonas; Karol Kamiński; Jarosław D Kasprzak; Piotr Podolec; Piotr Pruszczyk; Adam Torbicki; Marcin Kurzyna Journal: Ther Adv Chronic Dis Date: 2021-03-25 Impact factor: 5.091
Authors: Ina Jeong; Mona Alotaibi; Timothy M Fernandes; Suhyun Kim; Kim M Kerr; Jenny Yang; Victor Pretorius; Michael Madani; Nick H Kim Journal: Pulm Circ Date: 2022-07-01 Impact factor: 2.886