Roldan Tamara, Rios Juan J, Villamañan Elena, Waxman Aaron B
1 Department of Pharmacy, Brigham and Women's Hospital, Boston, MA, USA.
2 Department of Pharmacy, Hospital Universitario La Paz, Madrid, Spain.
Pulm Circ. 2017 Jul-Sep;7(3):692-701. doi: 10.1177/2045893217721903. Epub 2017 Jul 14.
Anticoagulants are widely used in patients with pulmonary arterial hypertension (PAH) to prolong survival. However, there is a lack of robust evidence demonstrating the benefits of anticoagulants in PAH patients and very little is known about the complications of their use in this population. The objective of this study is to compare the safety of routine administration of oral anticoagulants between PAH patients who were and were not treated with oral anticoagulants. This observational, retrospective cohort study included consecutive patients with confirmed PAH from two centers: Brigham and Women's Hospital in Boston and Hospital Universitario La Paz in Madrid from January 2009 to August 2015. The study group comprised patients who received therapeutic anticoagulation; patients who had never received anticoagulants were placed in the control group. Of the 201 included patients, 60.2% were treated with oral anticoagulants and 39.8% were not treated. The hazard ratio for major bleeding was 2.7 (95% confidence interval [CI] = 1.1-6.8; P = 0.036). The incidence rate for the anticoagulation group was 4.7 per 100 patient-years (95% CI = 2.5-8.0). The most frequent major hemorrhage was gastrointestinal bleeding with 24 cases (72.7%). Prior bleeding, poor anticoagulation, HAS-BLED score ≥3, diabetes, and number of medications were factors that increased the risk of major bleeding in patients using anticoagulants. The harmful effects of anticoagulants could outweigh the benefits in PAH patients. Therefore, anticoagulants should be prescribed on a case-by-case basis and should not be systematically recommended.
抗凝剂广泛应用于肺动脉高压（PAH）患者以延长生存期。然而，缺乏有力证据证明抗凝剂对PAH患者有益，且对于其在该人群中使用的并发症知之甚少。本研究的目的是比较接受和未接受口服抗凝剂治疗的PAH患者常规口服抗凝剂的安全性。这项观察性、回顾性队列研究纳入了2009年1月至2015年8月来自两个中心（波士顿的布里格姆妇女医院和马德里的拉巴斯大学医院）确诊为PAH的连续患者。研究组包括接受治疗性抗凝的患者；从未接受过抗凝剂治疗的患者被纳入对照组。在纳入的201例患者中，60.2%接受了口服抗凝剂治疗，39.8%未接受治疗。大出血的风险比为2.7（95%置信区间[CI]=1.1-6.8；P=0.036）。抗凝组的发病率为每100患者年4.7例（95%CI=2.5-8.0）。最常见的大出血是胃肠道出血，共24例（72.7%）。既往出血、抗凝不佳、HAS-BLED评分≥3、糖尿病和药物数量是使用抗凝剂患者大出血风险增加的因素。抗凝剂对PAH患者的有害影响可能超过益处。因此，抗凝剂应根据具体情况开具，不应系统推荐。
