Can anticoagulants improve the survival rate for patients with idiopathic pulmonary arterial hypertension? A systematic review and meta-analysis

Peijie, Wang; Liu, Hu; Yin, Yin; Yan, Dongqing; Zheng, Hongjie; Zhang, Junhang; Li, Yun

doi:10.1016/j.thromres.2020.08.024

Cited by 16 publications

(11 citation statements)

References 28 publications

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“…The largest registry analysis so far suggested a potential survival benefit associated with anticoagulation in patients with IPAH [319], but this finding was not confirmed by others [320]. Two recent meta-analyses also concluded that using anticoagulants may improve survival in patients with IPAH [321,322]; however, none of the included studies were methodologically robust. Despite the lack of evidence, registry data obtained between 2007 and 2016 showed that anticoagulation was used in 43% of patients with IPAH [293].…”

Section: Anticoagulationmentioning

confidence: 98%

See 1 more Smart Citation

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

Humbert

Kovàcs²,

Hoeper³

et al. 2022

Eur Respir J

1,177

1,631

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Section: Anticoagulationmentioning

confidence: 98%

“…Despite the lack of evidence, registry data obtained between 2007 and 2016 showed that anticoagulation was used in 43% of patients with IPAH [293]. In PAH associated with SSc, registry data and meta-analyses uniformly indicated that anticoagulation may be harmful [320][321][322]. In CHD, there are also no RCTs on anticoagulation.…”

Section: Anticoagulationmentioning

confidence: 99%

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

Humbert

Kovàcs²,

Hoeper³

et al. 2022

Eur Respir J

1,177

1,631

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“…Die Datenlage zur Therapie mit Blutverdünnern ist jedoch nicht eindeutig. Bei Patienten mit PAH, die mit systemischer Sklerose assoziiert ist, kann sich eine Therapie mit Antikoagulanzien negativ auswirken 24 , bei der Therapie bei PAH ist die Datenlage nicht konsistent 24 – 26 . Da eine Antikoagulation mit einem erhöhten Blutungsrisiko einhergeht und die Studien hierzu bei I/H/DPAH widersprüchliche Ergebnisse bezüglich der Frage Verbesserung der Letalität ergaben 24 , 25 , 26 , wurden keine generellen Empfehlungen ausgesprochen und auf individuelle Entscheidungen im Einzelfall verwiesen (Empfehlungsgrad II b C) 1 .…”

Section: Allgemeine Maßnahmenunclassified

Allgemeine Therapie der pulmonalarteriellen Hypertonie nach den neuen Leitlinien

Benjamin

Resag

Weinstock

et al. 2023

Aktuelle Kardiologie

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ZusammenfassungIn den neuen Leitlinien (LL) für pulmonalarterielle Hypertonie (PAH) sind die allgemeinen Maßnahmen ein integraler Bestandteil der Behandlung der Patienten. Auch die systemischen Auswirkungen der pulmonalen Hypertonie und Rechtsherzinsuffizienz sollten angemessen berücksichtigt und behandelt werden. Im folgenden Artikel werden die in den LL genannten Maßnahmen unter Berücksichtigung des bestehenden Empfehlungsgrads und der Evidenzen beschrieben. Leider sind die meisten Allgemeinmaßnahmen, wie die Gabe von Diuretika, Sauerstoff, psychosozialer Support und Impfungen, nicht oder unzureichend in randomisierten, kontrollierten Studien untersucht worden. So haben sie zwar einen hohen I-Empfehlungsgrad, aber einen niedrigen Evidenzgrad C. Nur bei dem spezialisierten körperlichen Training liegen bislang insgesamt 7 randomisierte, kontrollierte Studien und 5 Metaanalysen vor, die eine Verbesserung der Sauerstoffaufnahme, körperlichen Belastbarkeit, der Beschwerden (WHO-Funktionsklasse), Lebensqualität und Hämodynamik nachgewiesen haben (daher neu IA-Empfehlung). Auch weitere Maßnahmen wie die Antikoagulation, Eisensubstitution und andere werden im Folgenden besprochen.

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“…104 There have been no randomized studies of anticoagulation in PAH, but several systematic reviews of observational studies suggest that anticoagulation could be associated with improved survival. [105][106][107] Conversely, one meta-analysis using a Bayesian approach found that there was a 70% probability that warfarin provides no benefit or is harmful. 108 It is important to emphasize that the evidence supporting anticoagulation in patients with IPAH is conflicting, but several studies have suggested that anticoagulation is harmful in patients with systemic sclerosis (SSc)-associated PAH.…”

Section: Anticoagulationmentioning

confidence: 99%

Management of Pulmonary Arterial Hypertension

Weatherald

Varughese

Liu

et al. 2023

Semin Respir Crit Care Med

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Pulmonary arterial hypertension (PAH) is a rare pulmonary vascular disease characterized by progressive pulmonary arterial remodeling, increased pulmonary vascular resistance, right ventricular dysfunction, and reduced survival. Effective therapies have been developed that target three pathobiologic pathways in PAH: nitric oxide, endothelin-1, and prostacyclin. Approved therapies for PAH include phosphodiesterase type-5 inhibitors, soluble guanylate cyclase stimulators, endothelin receptor antagonists, prostacyclin analogs, and prostacyclin receptor agonists. Management of PAH in the modern era incorporates multidimensional risk assessment to guide the use of these medications. For patients with PAH and without significant comorbidities, current guidelines recommend two oral medications (phosphodiesterase type-5 inhibitor and endothelin receptor antagonist) for low- and intermediate-risk patients, with triple therapy including a parenteral prostacyclin to be considered in those at high or intermediate-high risk. Combination therapy may be poorly tolerated and less effective in patients with PAH and cardiopulmonary comorbidities. Thus, a single-agent approach with individualized decisions to add-on other PAH therapies is recommended in older patients and those with significant comorbid conditions. Management of PAH is best performed in multidisciplinary teams located in experienced centers. Other core pillars of PAH management include supportive and adjunctive treatments including oxygen, diuretics, rehabilitation, and anticoagulation in certain patients. Patients with PAH who progress despite optimal treatment or who are refractory to best medical care should be referred for lung transplantation, if eligible. Despite considerable progress, PAH is often fatal and new therapies that reverse the disease and improve outcomes are desperately needed.

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Can anticoagulants improve the survival rate for patients with idiopathic pulmonary arterial hypertension? A systematic review and meta-analysis

Cited by 16 publications

References 28 publications

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

Allgemeine Therapie der pulmonalarteriellen Hypertonie nach den neuen Leitlinien

Management of Pulmonary Arterial Hypertension

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