Oral anticoagulants (NOAC and VKA) in chronic thromboembolic pulmonary hypertension

Marc Humbert; Gérald Simonneau; David Pittrow; Marion Delcroix; Joanna Pepke-Zaba; David Langleben; Lisa M Mielniczuk; Pilar Escribano Subias; Repke J Snijder; Joan A Barberà; Jens Klotsche; Christian Meier; Marius M Hoeper

doi:10.1016/j.healun.2022.02.002

Oral anticoagulants (NOAC and VKA) in chronic thromboembolic pulmonary hypertension

J Heart Lung Transplant. 2022 Jun;41(6):716-721. doi: 10.1016/j.healun.2022.02.002. Epub 2022 Feb 11.

Authors

Affiliations

¹ Université Paris-Saclay, Inserm U999, Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France. Electronic address: marc.humbert@aphp.fr.
² Université Paris-Saclay, Inserm U999, Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France.
³ Institute for Clinical Pharmacology, Medical Faculty, Technical University, Dresden, Germany.
⁴ Clinical Department of Respiratory Diseases, University Hospitals and Laboratory of Respiratory Diseases and Thoracic Surgery and Department of Chronic Diseases and Metabolism, KU Leuven, University of Leuven, Leuven, Belgium.
⁵ Pulmonary Vascular Disease Unit, Royal Papworth Hospital, Cambridge, UK.
⁶ Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
⁷ Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
⁸ Cardiology Department and Spanish Cardiovascular Research Network, Hospital Universitario 12 de Octubre, Madrid, Spain.
⁹ Department of Pulmonology, St Antonius Ziekenhuis, Nieuwegein, The Netherlands.
¹⁰ Department of Pulmonary Medicine, Hospital Clínic-IDIBAPS, University of Barcelona, and Biomedical Research Networking Center on Respiratory Diseases, Madrid, Spain.
¹¹ German Rheumatism Research Centre Berlin, Leibniz Institute, Berlin, Germany.
¹² Bayer AG, Global Medical Affairs, Berlin, Germany.
¹³ Clinic for Respiratory Medicine, Hannover Medical School, German Center for Lung Research, Hannover, Germany.

PMID: 35305871
DOI: 10.1016/j.healun.2022.02.002

Abstract

EXPERT was an international, multicenter, prospective, uncontrolled, non-interventional cohort study in patients with pulmonary hypertension treated with riociguat. Patients were followed for 1-4 years, and the primary outcomes were adverse events (AEs) and serious AEs (SAEs), including embolic/thrombotic and hemorrhagic events. Here we report data on patients with chronic thromboembolic pulmonary hypertension (CTEPH) receiving a vitamin K antagonist (VKA; n = 683) or a non-vitamin K antagonist oral anticoagulant (NOAC; n = 198) at baseline. AEs and SAEs were reported in 438 patients (64.1%) and 257 patients (37.6%), respectively, in the VKA group, and in 135 patients (68.2%) and 74 patients (37.4%) in the NOAC group. Exposure-adjusted hemorrhagic event rates were similar in the two groups, while exposure-adjusted embolic and/or thrombotic event rates were higher in the NOAC group, although the numbers of events were small. Further studies are required to determine the long-term effects of anticoagulation strategies in CTEPH.

Keywords: chronic thromboembolic pulmonary hypertension; drug safety; non-vitamin K antagonist oral anticoagulants; riociguat; vitamin K antagonists.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Administration, Oral
Anticoagulants / adverse effects
Atrial Fibrillation*
Cohort Studies
Hemorrhage / chemically induced
Humans
Hypertension, Pulmonary* / chemically induced
Hypertension, Pulmonary* / complications
Hypertension, Pulmonary* / drug therapy
Prospective Studies
Vitamin K

Substances

Anticoagulants
Vitamin K