Said Karim
Aswan Heart Centre, Aswan, Egypt.
Glob Cardiol Sci Pract. 2014 Jun 18;2014(2):48-52. doi: 10.5339/gcsp.2014.25. eCollection 2014.
The use of anticoagulant therapy in patients with pulmonary arterial hypertension (PAH) has been controversial for decades. Recommendations for anticoagulation in these patients are often derived from small, retrospective, and single centre studies without any placebo-controlled randomized study. Furthermore, uncertainties exist regarding a number of issues such as patient selection, risk stratification for bleeding, the intensity of anticoagulation, appropriateness of anticoagulation in different types of PAH, and the potential use of new oral anticoagulants. Recently, the database of the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA) has been analyzed to assess the effect of anticoagulation on the long-term outcome of patients with various forms of PAH. This analysis is the largest to date to assess anticoagulant therapy in PAH patients in a prospective design with long observation period. The results of COMPERA lend support to current recommendations for the use of anticoagulant therapy in patients with idiopathic PAH, but not in other forms of PAH. Also, the study confirmed the previously reported concern that anticoagulant therapy may be harmful in patients with scleroderma-associated PAH.
几十年来，肺动脉高压（PAH）患者使用抗凝治疗一直存在争议。这些患者的抗凝建议通常来自小型、回顾性和单中心研究，没有任何安慰剂对照随机研究。此外，在患者选择、出血风险分层、抗凝强度、不同类型PAH抗凝的适宜性以及新型口服抗凝剂的潜在应用等诸多问题上仍存在不确定性。最近，对肺动脉高压新启动治疗比较、前瞻性注册数据库（COMPERA）进行了分析，以评估抗凝对各种形式PAH患者长期预后的影响。该分析是迄今为止在具有长期观察期的前瞻性设计中评估PAH患者抗凝治疗规模最大的一次。COMPERA的结果支持目前对特发性PAH患者使用抗凝治疗的建议，但不支持其他形式PAH患者。此外，该研究证实了之前报道的担忧，即抗凝治疗可能对硬皮病相关PAH患者有害。
