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.


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


  • Anticoagulants
  • Vitamin K