Anticoagulation therapy versus placebo for pulmonary hypertension

Ezedunukwe, Ifeanyi R; Enuh, Hilary; Nfonoyim, Jay; Enuh, Collins U

doi:10.1002/14651858.cd010695.pub2

Cited by 12 publications

(12 citation statements)

References 37 publications

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“…Рассмотрев четыре различных исследования антикоагулянтов у больных ЛАГ [27][28][29][30], рабочая группа CHEST в настоящее время не может дать рекомендаций относительно их применения.…”

Section: антикоагулянтная терапияunclassified

A systematic review as a method of gathering scientific evidence into clinical guidelines: CHEST-2019 guideline for the therapy pulmonary arterial hypertension in adults

Шмальц

Горбачевский

2019

Terapevticheskii arkhiv

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Section: антикоагулянтная терапияunclassified

A systematic review as a method of gathering scientific evidence into clinical guidelines: CHEST-2019 guideline for the therapy pulmonary arterial hypertension in adults

Шмальц

Горбачевский

2019

Terapevticheskii arkhiv

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“…These studies are summarized in Table 2. 11,21,22,[25][26][27][28][29][30][31][32][33][34][35][36] A mortality benefit in IPAH was shown in 6 of 12 (50%) studies. In general, the major shortcomings of these studies were related to the cohort representativity and comparability, small sample size, and patient and treatment selection biases.…”

Section: Efficacy Of Anticoagulation and Survival Of Patients With Pahmentioning

confidence: 99%

Anticoagulation in patients with pulmonary arterial hypertension: An update on current knowledge

Roldan

Landzberg

Deicicchi

et al. 2016

The Journal of Heart and Lung Transplantation

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Pulmonary hypertension is a severe clinical condition characterized by molecular and anatomic changes in pulmonary circulation. It is associated with increased pulmonary vascular resistance, which leads to right-sided heart failure if left untreated and, ultimately, death. Treatment of patients with pulmonary arterial hypertension (PAH) involves a complex strategy that takes into consideration disease severity, general and supportive measures, and combination drug regimens. Abnormalities of blood coagulation factors, anti-thrombotic factors, and the fibrinolytic system may contribute to a prothrombotic state in patients with idiopathic PAH. These physiologic changes, in concert with the presence of non-specific risk factors for venous thromboembolism such as heart failure and immobility, are thought to be the basis for oral anticoagulation in PAH. Several observational studies provide helpful information in favor of anticoagulation use in idiopathic PAH but not in other pulmonary hypertension etiologies. Guideline recommendations are based on the lack of prospective comparative trials in this regard. For that reason, large differences exist in the use of anticoagulants in different countries and centers. More studies should be carried out to clarify the risks and the potential benefits of anticoagulant use in a heterogeneous population of patients who are already at considerable life risk.

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“…Evidence of platelet function abnormalities and dysregulation of the coagulation cascade have been found in PAH patients [ 5 ]. The frequently contradictory reports found in the current literature, however, along with the relatively limited number of relevant studies, make it difficult for the complete nature of hemostatic abnormalities in the PAH setting to be adequately assessed [ 5 ].For example, even though classic studies in the PAH setting have shown evidence of vascular thrombotic lesions and in situ thrombosis in the small caliber peripheral pulmonary vessels in post-mortem evaluations in patients suffering from idiopathic pulmonary arterial hypertension (iPAH), some more recent studies were not able to provide evidence of increased thrombogenesis in the PAH population, while othersdid [ 5 , 6 , 7 ].Studies assessing markers of fibrinolysis have also rendered inconsistent results with some studies showing increased and others decreased fibrinolysis [ 5 , 7 ]. Furthermore, it has been observed that PAH patients frequently present with thrombocytopenia, the etiology of which has not yet been identified [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Coagulation Profiles of Pulmonary Arterial Hypertension Patients, Assessed by Non-Conventional Hemostatic Tests and Markers of Platelet Activation and Endothelial Dysfunction

et al. 2020

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Many pathophysiologic processes of pulmonary arterial hypertension (PAH), namely, excess vasoconstriction, vascular remodeling and in situ thrombosis, involve the coagulation cascade, and more specifically, platelets. The aim of this study was to globally assess coagulation processes in PAH, by using non-conventional hemostatic tests, along with markers of platelet activation and endothelial dysfunction. We studied 44 new PAH patients (22 with idiopathic PAH and 22 with connective tissue disease) and 25 healthy controls. The following tests were performed: platelet function analyzer-100 (PFA-100), light transmission aggregometry (LTA), rotational thromboelastometry (ROTEM), endogenous thrombin potential (ETP), serotonin, thromboxane A2 and p-selectin plasma levels, and von Willebrand antigen (VWF:Ag) and activity (VWF:Ac). Our results showed that PAH patients had diminished platelet aggregation, presence of disaggregation, defective initiation of the clotting process and clot propagation, and diminished thrombin formation capacity. Serotonin, thromboxane A2 and p-selectin levels were increased, and VWF:Ag and VWF:Ac decreased in the same population. The results of this study suggest that the platelets of PAH patients are activated and present functional abnormalities. The procoagulant activity, in general, appears to be impaired probably due to a sustained and prolonged activation of the procoagulant processes. Larger observational studies are warranted to confirm these laboratory findings.

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Anticoagulation therapy versus placebo for pulmonary hypertension

Cited by 12 publications

References 37 publications

A systematic review as a method of gathering scientific evidence into clinical guidelines: CHEST-2019 guideline for the therapy pulmonary arterial hypertension in adults

A systematic review as a method of gathering scientific evidence into clinical guidelines: CHEST-2019 guideline for the therapy pulmonary arterial hypertension in adults

Anticoagulation in patients with pulmonary arterial hypertension: An update on current knowledge

Coagulation Profiles of Pulmonary Arterial Hypertension Patients, Assessed by Non-Conventional Hemostatic Tests and Markers of Platelet Activation and Endothelial Dysfunction

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