Direct Oral Anticoagulants Versus Vitamin K Antagonists for the Treatment of Chronic Thromboembolic Pulmonary Hypertension: A Systematic Review and Meta-Analysis

Use of Oral Anticoagulant Drugs in Patients with Pulmonary Hypertension

“…Notwithstanding, so far only very few observational studies have addressed this issue 35 . Recently, two systematic reviews emerged from the literature 36,37 . In the paper by Sedhom and colleagues, 6 cohorts were included in the systematic review, for a total of 2145 patients.…”

“…In this study, the authors underlined a trend in lower risk of major bleeding in patients treated with DOACs, with a still contradictory impact in terms of thrombotic event recurrence 37 . In another systematic review and meta-analysis, presented during the latest American College of Cardiology meeting, the authors included 4 observational studies with a total of 1750 patients with CTEPH, showing a safety advantage of DOACs treatment 36 . Indeed, while there was no significant difference in terms thrombotic event recurrence (odds ratio [OR] 2.07, 95% CI 0.65-6.65), the risk of major bleeding was significantly lower with DOACs than VKAs (OR 0.51, 95% CI 0.28-0.93) 36 , also with no relevant heterogeneity regarding this pooled outcome data (I 2 0%).…”

“…Results coming from single studies, as well as the pooled data coming from the recent systematic reviews and meta-analyses 36,37 , suggest that DOACs represent a safe alternative to VKAs, and also underline the need for more solid and wellconducted studies to elucidate the actual impact of DOACs vs VKAs in patients with CTEPH and PAH, also taking proper account of issues regarding bioaccumulation and drug-drug interactions 51 .…”