Pulmonary Vascular Disease |

Effect of Long-term Oral Anticoagulation in Pulmonary Arterial Hypertension (PAH) FREE TO VIEW

Adriano Tonelli; Omar Minai
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Cleveland Clinic, Cleveland, OH

Chest. 2014;146(4_MeetingAbstracts):861A. doi:10.1378/chest.1988846
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SESSION TITLE: Pulmonary Hypertension

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Tuesday, October 28, 2014 at 02:45 PM - 04:15 PM

PURPOSE: Retrospective studies, mostly done before the availability of PAH-specific therapies, suggested that anticoagulation increases survival in PAH. Recent data from a European PAH registry reported that the use of oral anticoagulation was associated with a survival benefit in patients with idiopathic PAH. However, further studies are needed to appropriately assess the risk / benefit ratio of anticoagulation at the present time.

METHODS: We use observational long-term data on PAH patients treated with subcutaneous treprostinil designed to assess long-term benefits of the medication. Patients rolled over from previous randomized study or were de novo patients. In this extension study, patients were followed for up to 4 years. Survival was assessed from the start of SQ treprostinil to death or data cut-off. Patients were censored if they underwent transplantation or discontinued treprostinil.

RESULTS: At total of 933 patients (age [mean ± SD] 45.7 ± 15 years, 76% female, 83% Caucasian, 50% idiopathic PAH, and 76.6% NYHA functional class III) were included. Baseline six-minute walk distance (6MWD) and pulmonary vascular resistance (PVR) were 329 ± 86 m and 14 ± 7 Wood units. All patients received SQ treprostinil (15% also other PH-therapies). Patients on warfarin had a higher proportion of women (79 vs 70%, p<0.01) and more idiopathic PAH (54 vs 44 %). There were no differences in unadjusted long-term survival between patients receiving warfarin or not (log-rank test p value=0.19) in PAH or when only considering the patients with idiopathic PAH (p=0.88). In a multivariate model adjusted by age, PAH etiology, NYHA functional class, right atrial pressure, PVR, and treatment with aspirin, treatment with warfarin was not a significant predictor of survival (p=0.11) or change in 6MWD (p=0.56) in PAH.

CONCLUSIONS: Long-term anticoagulation with warfarin appeared to not have a significant effect on survival in the PAH or idiopathic PAH patients treated with SQ treprostinil.

CLINICAL IMPLICATIONS: There appears to be no long-term survival benefits of warfarin in PAH patients treated with SQ treprostinil.

DISCLOSURE: Omar Minai: Consultant fee, speaker bureau, advisory committee, etc.: Actelion, United Therapeutics, Gilead, Bayer The following authors have nothing to disclose: Adriano Tonelli

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