The role of anticoagulation on the long-term survival of patients with pulmonary arterial hypertension: A meta-analysis of 15 cohort studies

Xinwang Chen; Zhenguo Zhai; Lan Lin; Dan Xue; Xiangqi Chen; Hong Zhang; Qiong Lin

doi:10.1016/j.thromres.2024.109173

The role of anticoagulation on the long-term survival of patients with pulmonary arterial hypertension: A meta-analysis of 15 cohort studies

Thromb Res. 2024 Nov:243:109173. doi: 10.1016/j.thromres.2024.109173. Epub 2024 Sep 29.

Authors

Xinwang Chen¹, Zhenguo Zhai², Lan Lin¹, Dan Xue¹, Xiangqi Chen¹, Hong Zhang³, Qiong Lin⁴

Affiliations

¹ Department of Pulmonary and Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou, China.
² Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Center for Respiratory Medicine, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China.
³ College of Environmental and Resource Science, Fujian Normal University, Fuzhou, China. Electronic address: zhanghong@fjnu.edu.cn.
⁴ Department of Pulmonary and Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou, China. Electronic address: linqiong22558188@fjmu.edu.cn.

PMID: 39366111
DOI: 10.1016/j.thromres.2024.109173

Abstract

Introduction: Anticoagulation was once recommended for patients with pulmonary arterial hypertension (PAH). However, its survival benefit still remained controversial. We performed a meta-analysis to evaluate the effect of anticoagulation on the long-term survival of PAH patients.

Methods: The PubMed, EMBASE, Web of Science, and WanFang electronic database were searched for eligible studies. Pooled hazard ratios (HRs) with 95 % confidence intervals (CIs) were calculated for effect estimate regarding anticoagulation on the survival of PAH patients.

Results: Fifteen cohort studies involving 4266 PAH patients were included. Approximately 45.8 % patients received anticoagulation. The mean follow-up period ranged from 2.1 to 14 years. Anticoagulation had a tendency to, however, did not significantly reduce mortality of PAH patients (HR: 0.86, 95 % CI: 0.73-1.02). In subgroup analysis, anticoagulation decreased the mortality risk as analyzed from retrospective studies (HR: 0.80, 95 % CI: 0.65-0.98), but not prospective studies (HR: 0.95, 95 % CI: 0.70-1.29). For both idiopathic PAH (IPAH) and connective tissue disease associated PAH (CTD-PAH), anticoagulation therapy did not significantly improve the long-term survival rate (HR: 0.83, 95 % CI: 0.65-1.07, and HR: 1.05, 95 % CI: 0.77-1.42, respectively), and this result remained unchanged when pooling data from either retrospective or prospective studies. Further analysis showed that anticoagulation had no advantage in reducing mortality in patients with systemic sclerosis associated PAH, systemic erythematosus lupus related PAH (free of antiphospholipid syndrome), or CTD-PAH of non-specified etiology.

Conclusion: Anticoagulation may not reduce the long-term mortality of PAH patients, including those with IPAH and CTD-PAH. In the management of PAH, anticoagulants should be prescribed with caution before comprehensive risk to benefit evaluation. Larger and more vigorously designed controlled trials are warranted.

Keywords: Anticoagulation; Meta-analysis; Pulmonary arterial hypertension; Pulmonary hypertension.

Publication types

Meta-Analysis

MeSH terms

Anticoagulants* / therapeutic use
Cohort Studies
Humans
Pulmonary Arterial Hypertension* / drug therapy
Pulmonary Arterial Hypertension* / mortality

Substances

Anticoagulants