Effects of a combination therapy of anticoagulant and vasodilator on the long-term prognosis of primary pulmonary hypertension.

Ogata, Masahiko; Ohe, Masatoshi; Shirato, Kunio; Takishima, Tamotsu

doi:10.1253/jcj.57.63

Cited by 38 publications

(18 citation statements)

References 12 publications

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“…Observational studies evaluating a role for anticoagulation in PAH, with mortality as an end point, are summarised in Table 1. 8,[13][14][15][16][18][19][20][21] While the findings of these observational studies are important for generating hypotheses regarding potential benefits of therapies, such studies may be biased because of non-random allocation of treatment and 'confounding by indication'.…”

Section: Observational Studies Of Anticoagulation In Pahmentioning

confidence: 99%

Should patients with systemic sclerosis‐related pulmonary arterial hypertension be anticoagulated?

Nikpour

Stevens

Proudman

et al. 2013

Internal Medicine Journal

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Pulmonary arterial hypertension (PAH) is a major cause of mortality in scleroderma and despite 'advanced' therapies confers a median survival of less than 5 years. Anticoagulation in systemic sclerosis-related PAH (SSc-PAH) is currently one of the most contentious issues in the management of patients with connective tissue disease. While some studies have shown a survival benefit with warfarin therapy in this disease, others have not. Accordingly, a state of clinical equipoise exists in relation to anticoagulation in SSc-PAH. With an over fivefold reduction in mortality demonstrated in some observational studies, the issue of anticoagulation in SSc-PAH demands resolution through a well-designed randomised controlled trial.

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Section: Observational Studies Of Anticoagulation In Pahmentioning

confidence: 99%

Should patients with systemic sclerosis‐related pulmonary arterial hypertension be anticoagulated?

Nikpour

Stevens

Proudman

et al. 2013

Internal Medicine Journal

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“…If, during RHC, the pulmonary vasoreactive tests are positive, the treatment of choice is high-dose CCBs, as improved survival with long-term use has been demonstrated in this cohort of patients. 42,43 Vasoreactivity is considered to be present when the mPAP has decreased by at least 10 mmHg to 40 mmHg or less with normal or high cardiac output after intervention with pulmonary vasodilators, such as 100% oxygen, nitric oxide inhalation or intravenous prostacyclin. 35 However, less than 10% of patients with iPAH respond long term to CCB therapy and even less in other associated conditions, such as PAH related to CTD: in many cases the test is omitted because the response is so infrequent.…”

Section: Conventional Treatmentmentioning

confidence: 99%

Integrated care and optimal management of pulmonary arterial hypertension

Strange

Fowler

Jary

et al. 2009

JMDH

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Pulmonary arterial hypertension (PAH) may occur as an idiopathic process or as a component of a variety of diseases, including connective tissue diseases, congenital heart disease, and exposure to appetite suppressants or infectious agents such as HIV. Untreated, it is a potentially devastating disease; however, diagnosis can be difficult due to the non-specific nature of symptoms during the early stages, and the fact that patients often present to a range of different medical specialties. The past decade has seen remarkable improvements in our understanding of the pathology associated with the condition and the development of PAH-specific therapies with the ability to alter the natural history of the disease. This article reviews the evidence for screening and diagnosis of susceptible patient groups and discusses treatment selection and recommendations based on data available from randomized controlled trials. In addition, due to the complexity of the diagnostic evaluation required and the treatment options available, this review mandates for a multidisciplinary approach to the management of PAH. We discuss the roles and organizational structure of a specialized PAH center in Perth, Western Australia to highlight these issues.

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“…Patients with idiopathic PAH who respond to vasodilators in the short term have improved survival with longterm use of calcium-channel blockers (46,49). Various short-acting agents, including intravenous epoprostenol or adenosine and inhaled nitric oxide, have been used to test short-term response to vasodilators (50,51).…”

Section: Vasodilator Testing and Calcium-channel Blockersmentioning

confidence: 99%

Evaluation and Management of the Patient with Pulmonary Arterial Hypertension

Rubin

Badesch²

2005

Ann Intern Med

126

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Increased pressure in the pulmonary circulation, or pulmonary hypertension, is a common disorder that may complicate various cardiopulmonary conditions, including severe obstructive airways disease and left ventricular dysfunction. An increase in pulmonary arterial pressure that is not due to coexistent cardiopulmonary disease, known as pulmonary arterial hypertension, may occur in the absence of a demonstrable cause (idiopathic or familial); as a complication of systemic conditions, such as connective tissue disease, HIV infection, or chronic liver disease; or as a result of the use of fenfluramine anorexigens, amphetamines, or cocaine. The development of disease-specific therapies for pulmonary arterial hypertension over the past decade underscores the importance of diagnosing pulmonary hypertension early in the course of the condition and implementing a treatment strategy that is based on the condition's cause and severity. In this review, the authors present approaches to the diagnosis and management of pulmonary arterial hypertension, using a hypothetical case to highlight the key management points. U ntil recently, management of pulmonary arterial hypertension (PAH) was generally ineffective in alleviating symptoms or improving survival. However, the past decade has witnessed remarkable advances in our understanding of the pathogenesis of PAH, advances that have led to the development of disease-specific treatments. Despite these achievements, PAH remains a challenging condition to diagnose and manage. This article reviews recent developments in the diagnosis and management of PAH in the context of a typical case, illustrating the importance of collaboration between the internist and the specialist in patient care.

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Effects of a combination therapy of anticoagulant and vasodilator on the long-term prognosis of primary pulmonary hypertension.

Cited by 38 publications

References 12 publications

Should patients with systemic sclerosis‐related pulmonary arterial hypertension be anticoagulated?

Should patients with systemic sclerosis‐related pulmonary arterial hypertension be anticoagulated?

Integrated care and optimal management of pulmonary arterial hypertension

Evaluation and Management of the Patient with Pulmonary Arterial Hypertension

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