Clinical outcomes between direct oral anticoagulants versus vitamin K antagonists in chronic thromboembolic pulmonary hypertension: A systematic review and meta-analysis

Pulmonary hypertension (PH) is a known chronic condition that can lead to increased morbidity and mortality. Patients who develop PH due to thromboembolic disease are catalogued as chronic thromboembolic pulmonary hypertension (CTEPH). Anticoagulation remains a topic of interest in these patients. P...

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Published in:Current problems in cardiology 2024-03, Vol.49 (3), p.102377, Article 102377
Main Authors: Salazar, Adolfo Martinez, Panama, Gabriel, Kim, Andrew Geunwon, Rayamajhi, Supratik, Abela, George S
Format: Article
Language:English
Subjects:
Administration, Oral
Anticoagulants - adverse effects
Fibrinolytic Agents - therapeutic use
Hemorrhage - chemically induced
Humans
Hypertension, Pulmonary - drug therapy
Hypertension, Pulmonary - etiology
Venous Thromboembolism - drug therapy
Venous Thromboembolism - etiology
Vitamin K
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Summary:Pulmonary hypertension (PH) is a known chronic condition that can lead to increased morbidity and mortality. Patients who develop PH due to thromboembolic disease are catalogued as chronic thromboembolic pulmonary hypertension (CTEPH). Anticoagulation remains a topic of interest in these patients. PUBMED, EMBASE and COCHRANE databases were searched by two investigators until December 2023. Information was analyzed for all-cause mortality, venous thromboembolism and major bleeding. We included a total of 10 studies in this meta-analysis. Our pooled analysis demonstrated that DOACs were non-inferior in all-cause mortality [OR 0.88, 95 % CI (0.48, 1.61)], venous thromboembolism [OR 1.00, 95 % CI (0.50, 1.98)] and major bleeding [OR 0.78, 95 % CI (0.43, 1.40)] when compared to VKAs. In conclusion, our meta-analysis supports the use of DOACs in patients with CTEPH. Further randomized trials are still needed to confirm our results in terms of safety and mortality
ISSN:0146-2806
1535-6280
1535-6280
DOI:10.1016/j.cpcardiol.2024.102377