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A multicenter study of anticoagulation in operable chronic thromboembolic pulmonary hypertension

Lookup NU author(s): Emeritus Professor Paul Corris


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© 2019 International Society on Thrombosis and HaemostasisBackground: 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.

Publication metadata

Author(s): Bunclark K, Newnham M, Chiu Y-D, Ruggiero A, Villar SS, Cannon JE, Coghlan G, Corris PA, Howard L, Jenkins D, Johnson M, Kiely DG, Ng C, Screaton N, Sheares K, Taboada D, Tsui S, Wort SJ, Pepke-Zaba J, Toshner M

Publication type: Article

Publication status: Published

Journal: Journal of Thrombosis and Haemostasis

Year: 2020

Volume: 18

Issue: 1

Pages: 114-122

Print publication date: 01/01/2020

Online publication date: 26/09/2019

Acceptance date: 23/09/2019

ISSN (print): 1538-7933

ISSN (electronic): 1538-7836

Publisher: Blackwell Publishing Ltd


DOI: 10.1111/jth.14649

PubMed id: 31557382


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