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著者: Katherine Bunclark, Michael Newnham, Yi-Da Chiu, Alessandro Ruggiero, Sofia S Villar, John E Cannon, Gerry Coghlan, Paul A Corris, Luke Howard, David Jenkins, Martin Johnson, David G Kiely, Choo Ng, Nicholas Screaton, Karen Sheares, Dolores Taboada, Steven Tsui, Stephen John Wort, Joanna Pepke-Zaba, Mark Toshner
雑誌名: J Thromb Haemost. 2020 Jan;18(1):114-122. doi: 10.1111/jth.14649. Epub 2019 Oct 18.
Abstract/Text
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.
© 2019 International Society on Thrombosis and Haemostasis.
PMID 31557382 J Thromb Haemost. 2020 Jan;18(1):114-122. doi: 10.1111/jth.14649. Epub 2019 Oct 18.
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