A multicenter study of anticoagulation in operable chronic thromboembolic pulmonary hypertension

Katherine  Bunclark; Michael Newnham; Yi-Da  Chiu; Alessandro  Ruggiero; Sofía S Villar; John E  Cannon; Gerry Coghlan; Paul A. Corris; Luke Howard; David Jenkins; Martin Johnson; David G Kiely; Choo Ng; Nicholas Screaton; Karen Sheares; Dolores Taboada; Steven Tsui; S John  Wort; Joanna Pepke-Zaba; Mark Toshner

doi:10.1111/jth.14649

A multicenter study of anticoagulation in operable chronic thromboembolic pulmonary hypertension

Katherine Bunclark, Michael Newnham, Yi-Da Chiu, Alessandro Ruggiero, Sofía S Villar, John E Cannon, Gerry Coghlan, Paul A. Corris, Luke Howard, David Jenkins, Martin Johnson, David G Kiely, Choo Ng, Nicholas Screaton, Karen Sheares, Dolores Taboada, Steven Tsui, S John Wort, Joanna Pepke-Zaba, Mark Toshner

Applied Health Research

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Abstract

Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is an uncommon complication of acute pulmonary emboli necessitating lifelong anticoagulation. Despite this, few data exist on the safety and efficacy of vitamin K antagonists (VKAs) in CTEPH and none for direct oral anticoagulants (DOACs).
Objectives: To evaluate outcomes and complication rates in CTEPH following pulmonary endarterectomy (PEA) for individuals receiving VKAs or DOACs.
Methods: Consecutive CTEPH patients undergoing PEA between 2007 and 2018 were included in a retrospective analysis. Postoperative outcomes, recurrent venous thromboembolism (VTE), and bleeding events were obtained from patient medical records.
Results: Seven hundred ninety‐four individuals were treated with VKAs and 206 with DOACs following PEA. Mean observation period was 612 (standard deviation: 702) days. Significant improvements in hemodynamics and functional status were observed in both groups following PEA (P < .001). Major bleeding events were equivalent (P = 1) in those treated with VKAs (0.67%/person‐year) and DOACs (0.68%/person‐year). The VTE recurrence was proportionately higher (P = .008) with DOACs (4.62%/person‐year) than VKAs (0.76%/person‐year), although survival did not differ.
Conclusions: Post‐PEA functional and hemodynamic outcomes appear unaffected by anticoagulant choice. Bleeding events were similar, but recurrent VTE rates significantly higher in those receiving DOACs. Our study provides a strong rationale for prospective registry data and/or studies to evaluate the safety of DOACs in CTEPH.

Original language	English
Pages (from-to)	114-122
Number of pages	9
Journal	Journal of Thrombosis and Haemostasis
Volume	18
Issue number	1
Early online date	26 Sept 2019
DOIs	https://doi.org/10.1111/jth.14649
Publication status	Published - Jan 2020

Keywords

Anticoagulant
Complications
Pulmonary hypertension
Venous thromboembolism
Warfarin

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Bunclark_et_al_A_multicenter_study_of_anticoagulation_Journal_of_Thrombosis_and_Haemostasis_2019
This is the peer reviewed version of the following article: Bunclark, K, Newnham, M, Chiu, Y‐D, et al. A multicenter study of anticoagulation in operable chronic thromboembolic pulmonary hypertension. J Thromb Haemost 2019, which has been published in final form at https://doi.org/10.1111/jth.14649 00: 1– 9. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
Accepted author manuscript, 246 KBLicence: Other (please specify with Rights Statement)

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Bunclark, K., Newnham, M., Chiu, Y-D., Ruggiero, A., Villar, S. S., Cannon, J. E., Coghlan, G., Corris, P. A., Howard, L., Jenkins, D., Johnson, M., Kiely, D. G., Ng, C., Screaton, N., Sheares, K., Taboada, D., Tsui, S., Wort, S. J., Pepke-Zaba, J., & Toshner, M. (2020). A multicenter study of anticoagulation in operable chronic thromboembolic pulmonary hypertension. Journal of Thrombosis and Haemostasis, 18(1), 114-122. Advance online publication. https://doi.org/10.1111/jth.14649

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title = "A multicenter study of anticoagulation in operable chronic thromboembolic pulmonary hypertension",

abstract = "Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is an uncommon complication of acute pulmonary emboli necessitating lifelong anticoagulation. Despite this, few data exist on the safety and efficacy of vitamin K antagonists (VKAs) in CTEPH and none for direct oral anticoagulants (DOACs).Objectives: To evaluate outcomes and complication rates in CTEPH following pulmonary endarterectomy (PEA) for individuals receiving VKAs or DOACs.Methods: Consecutive CTEPH patients undergoing PEA between 2007 and 2018 were included in a retrospective analysis. Postoperative outcomes, recurrent venous thromboembolism (VTE), and bleeding events were obtained from patient medical records.Results: Seven hundred ninety‐four individuals were treated with VKAs and 206 with DOACs following PEA. Mean observation period was 612 (standard deviation: 702) days. Significant improvements in hemodynamics and functional status were observed in both groups following PEA (P < .001). Major bleeding events were equivalent (P = 1) in those treated with VKAs (0.67%/person‐year) and DOACs (0.68%/person‐year). The VTE recurrence was proportionately higher (P = .008) with DOACs (4.62%/person‐year) than VKAs (0.76%/person‐year), although survival did not differ.Conclusions: Post‐PEA functional and hemodynamic outcomes appear unaffected by anticoagulant choice. Bleeding events were similar, but recurrent VTE rates significantly higher in those receiving DOACs. Our study provides a strong rationale for prospective registry data and/or studies to evaluate the safety of DOACs in CTEPH.",

keywords = "Anticoagulant, Complications, Pulmonary hypertension, Venous thromboembolism, Warfarin",

author = "Katherine Bunclark and Michael Newnham and Yi-Da Chiu and Alessandro Ruggiero and Villar, {Sof{\'i}a S} and Cannon, {John E} and Gerry Coghlan and Corris, {Paul A.} and Luke Howard and David Jenkins and Martin Johnson and Kiely, {David G} and Choo Ng and Nicholas Screaton and Karen Sheares and Dolores Taboada and Steven Tsui and Wort, {S John} and Joanna Pepke-Zaba and Mark Toshner",

year = "2020",

month = jan,

doi = "10.1111/jth.14649",

language = "English",

volume = "18",

pages = "114--122",

journal = "Journal of Thrombosis and Haemostasis",

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Bunclark, K, Newnham, M, Chiu, Y-D, Ruggiero, A, Villar, SS, Cannon, JE, Coghlan, G, Corris, PA, Howard, L, Jenkins, D, Johnson, M, Kiely, DG, Ng, C, Screaton, N, Sheares, K, Taboada, D, Tsui, S, Wort, SJ, Pepke-Zaba, J & Toshner, M 2020, 'A multicenter study of anticoagulation in operable chronic thromboembolic pulmonary hypertension', Journal of Thrombosis and Haemostasis, vol. 18, no. 1, pp. 114-122. https://doi.org/10.1111/jth.14649

TY - JOUR

T1 - A multicenter study of anticoagulation in operable chronic thromboembolic pulmonary hypertension

AU - Bunclark, Katherine

AU - Newnham, Michael

AU - Chiu, Yi-Da

AU - Ruggiero, Alessandro

AU - Villar, Sofía S

AU - Cannon, John E

AU - Coghlan, Gerry

AU - Corris, Paul A.

AU - Howard, Luke

AU - Jenkins, David

AU - Johnson, Martin

AU - Kiely, David G

AU - Ng, Choo

AU - Screaton, Nicholas

AU - Sheares, Karen

AU - Taboada, Dolores

AU - Tsui, Steven

AU - Wort, S John

AU - Pepke-Zaba, Joanna

AU - Toshner, Mark

PY - 2020/1

Y1 - 2020/1

N2 - Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is an uncommon complication of acute pulmonary emboli necessitating lifelong anticoagulation. Despite this, few data exist on the safety and efficacy of vitamin K antagonists (VKAs) in CTEPH and none for direct oral anticoagulants (DOACs).Objectives: To evaluate outcomes and complication rates in CTEPH following pulmonary endarterectomy (PEA) for individuals receiving VKAs or DOACs.Methods: Consecutive CTEPH patients undergoing PEA between 2007 and 2018 were included in a retrospective analysis. Postoperative outcomes, recurrent venous thromboembolism (VTE), and bleeding events were obtained from patient medical records.Results: Seven hundred ninety‐four individuals were treated with VKAs and 206 with DOACs following PEA. Mean observation period was 612 (standard deviation: 702) days. Significant improvements in hemodynamics and functional status were observed in both groups following PEA (P < .001). Major bleeding events were equivalent (P = 1) in those treated with VKAs (0.67%/person‐year) and DOACs (0.68%/person‐year). The VTE recurrence was proportionately higher (P = .008) with DOACs (4.62%/person‐year) than VKAs (0.76%/person‐year), although survival did not differ.Conclusions: Post‐PEA functional and hemodynamic outcomes appear unaffected by anticoagulant choice. Bleeding events were similar, but recurrent VTE rates significantly higher in those receiving DOACs. Our study provides a strong rationale for prospective registry data and/or studies to evaluate the safety of DOACs in CTEPH.

AB - Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is an uncommon complication of acute pulmonary emboli necessitating lifelong anticoagulation. Despite this, few data exist on the safety and efficacy of vitamin K antagonists (VKAs) in CTEPH and none for direct oral anticoagulants (DOACs).Objectives: To evaluate outcomes and complication rates in CTEPH following pulmonary endarterectomy (PEA) for individuals receiving VKAs or DOACs.Methods: Consecutive CTEPH patients undergoing PEA between 2007 and 2018 were included in a retrospective analysis. Postoperative outcomes, recurrent venous thromboembolism (VTE), and bleeding events were obtained from patient medical records.Results: Seven hundred ninety‐four individuals were treated with VKAs and 206 with DOACs following PEA. Mean observation period was 612 (standard deviation: 702) days. Significant improvements in hemodynamics and functional status were observed in both groups following PEA (P < .001). Major bleeding events were equivalent (P = 1) in those treated with VKAs (0.67%/person‐year) and DOACs (0.68%/person‐year). The VTE recurrence was proportionately higher (P = .008) with DOACs (4.62%/person‐year) than VKAs (0.76%/person‐year), although survival did not differ.Conclusions: Post‐PEA functional and hemodynamic outcomes appear unaffected by anticoagulant choice. Bleeding events were similar, but recurrent VTE rates significantly higher in those receiving DOACs. Our study provides a strong rationale for prospective registry data and/or studies to evaluate the safety of DOACs in CTEPH.

KW - Anticoagulant

KW - Complications

KW - Pulmonary hypertension

KW - Venous thromboembolism

KW - Warfarin

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U2 - 10.1111/jth.14649

DO - 10.1111/jth.14649

M3 - Article

SN - 1538-7933

VL - 18

SP - 114

EP - 122

JO - Journal of Thrombosis and Haemostasis

JF - Journal of Thrombosis and Haemostasis

IS - 1

ER -

A multicenter study of anticoagulation in operable chronic thromboembolic pulmonary hypertension

Abstract

Keywords

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