Affect of Warfarin on Pulmonary Arterial Hypertension (PAH) Mortality: Facts Have Changed?

Saeed, Wajeeha; Tiwari, Nidhish; Salamon, Jason N.; Sardar, Muhammad; Rab, Zia; Zolty, Ronald

doi:10.1016/j.cardfail.2011.06.239

Cited by 5 publications

(4 citation statements)

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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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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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show abstract

“…Retrospective studies, mostly performed before the availability of PAH‐specific therapies, suggest that oral anticoagulants increase survival in PAH . More contemporary studies corroborated that warfarin use was associated with improved survival, particularly at one year . Two systematic reviews (one with meta‐analysis) revealed that anticoagulation decreases mortality risk in PAH patients .…”

Section: Introductionmentioning

confidence: 99%

Impact on survival of warfarin in patients with pulmonary arterial hypertension receiving subcutaneous treprostinil

Ascha

Zhou

Rao

et al. 2017

Cardiovascular Therapeutics

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Introduction Anticoagulation is a common treatment modality in patients with pulmonary arterial hypertension (PAH). Further studies are needed to appropriately assess the risk / benefit ratio of anticoagulation, particularly in PAH patients receiving PAH-specific therapies. Aims We use observational long-term data on PAH patients treated with subcutaneous (SQ) treprostinil from a large open-label study. Patients were followed for up to four years. The use of warfarin and bleeding events were recorded. Results At total of 860 patients (age [mean ± SD] 46 ± 15 years, 76% female, 83% Caucasian, 49% idiopathic PAH, and 76% NYHA functional class III) were included. All patients received SQ treprostinil (15% also other PH-therapies) and 590 (69%) received warfarin during the study. The proportions of women, African-American and IPAH patients were higher in the group receiving warfarin. A higher proportion of patients with congenital heart disease and porto-pulmonary hypertension did not receive warfarin. There were no differences in unadjusted long-term survival between PAH patients receiving warfarin or not (log-rank test, p value=0.69), even when only considering idiopathic PAH (p=0.32). In addition, no difference was found in adjusted long-term survival both in PAH (p=0.84) and idiopathic PAH patients (p=0.44) based on the use of warfarin. Furthermore, no survival difference based on the use of warfarin were noted between propensity score matched PAH patients (p=0.37). Conclusions Long-term anticoagulation with warfarin was not associated with any significant effect on survival in PAH or idiopathic PAH patients treated with SQ treprostinil.

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“…In Colombia, it is estimated that between 0.1 and 0.2% of deaths occur as a result of rheumatic disease [5] . Delay in the treatment of MS leads to complications like atrial fibrillation and pulmonary hypertension [6][7][8] . In 1984, Inoue et al described the first percutaneous mitral balloon valvuloplasty (PMBV) and since then, the Inoue technique has been shown to produce excellent hemodynamic results in patients with severe rheumatic mitral stenosis [9] .…”

Section: Introductionmentioning

confidence: 99%

Long-term Outcomes after Percutaneous Mitral Valvuloplasty in Colombia, South America

Saeed¹

2015

JHC

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Objective: To evaluate the long term clinical results of percutaneous mitral balloon valvuloplasty in patients with rheumatic mitral stenosis in Colombia, South America. Background: In 1993, Colombia, South America began a National Mitral Balloon Valvuloplasty Registry. This multicenter database was designed to establish the longterm safety and efficacy of percutaneous mitral valvuloplasty, as well as rate of restenosis. Methods: Between January 1993 and December 2011, 182 patients >18 years old were treated for rheumatic mitral stenosis with percutaneous valvuloplasty in two centers in Colombia, South America. Clinical, echocardiographic and hemodynamic data were stored in an electronic database. The Inoue Balloon technique was used in 99% of patients. The longest follow-up period was 15 years. Results: 182 patients were included; women (89%), hypertension (19%), dyslipidemia (1.6%), smoking (8.8%), diabetes (5.5%) and renal failure (1%). Forty-six patients (25.7%) were NYHA functional class III-IV. Procedure related mortality was 1.09% (2 patients). Fourteen patients (7.69%) had significant post procedure mitral insufficiency (grades III-IV); 4 patients (2.19%) had cardiac tamponade and 6 patients (3.3%) had vascular site related complications. The survival rate at 12 months was 96%. At 50 months, 60.7% of patients were alive and free of mitral surgery and repeated mitral valvuloplasty. The percentage of severe restenosis of mitral valve was 4.8%, 19.2%, 15.2% at one, five and 10 years of follow-up. Conclusions: Percutaneous mitral valvuloplasty using the Inoue balloon technique improves the hemodynamic profile of severe mitral stenosis. Long-term follow-up suggest that it is a safe alternative to mitral valve surgery in well selected patients.

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Affect of Warfarin on Pulmonary Arterial Hypertension (PAH) Mortality: Facts Have Changed?

Cited by 5 publications

References 0 publications

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

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

Impact on survival of warfarin in patients with pulmonary arterial hypertension receiving subcutaneous treprostinil

Long-term Outcomes after Percutaneous Mitral Valvuloplasty in Colombia, South America

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