Jeong Ina, Alotaibi Mona, Fernandes Timothy M, Kim Suhyun, Kerr Kim M, Yang Jenny, Pretorius Victor, Madani Michael, Kim Nick H
Division of Pulmonary and Critical Care Medicine National Medical Center Seoul Korea.
Division of Pulmonary, Critical Care and Sleep Medicine University of California San Diego USA.
Pulm Circ. 2022 Jul 1;12(3):e12110. doi: 10.1002/pul2.12110. eCollection 2022 Jul.
Patients with chronic thromboembolic pulmonary hypertension (CTEPH) require lifelong anticoagulant therapy. The safety and efficacy of direct oral anticoagulant (DOAC) in the chronic and transitional management of CTEPH has not been investigated. We performed a retrospective analysis of 405 consecutive pulmonary endarterectomy (PEA) cases at the University of California, San Diego, from July 2015 through July 2017. PEA specimen was reviewed for the presence of acute or subacute thrombotic material distinct from the expected chronic disease removed at the time of PEA by two investigators blinded to the patient information. Of 405 PEA cases, 166 patients (41.0%) were anticoagulated with one of three available DOACs; 239 (59.0%) presented on either oral vitamin-K antagonist or chronic injectable therapy. There were no significant differences in baseline characteristics between DOAC and non-DOAC groups. Evidence of recent thrombus was observed in 22 (13.3%) in the DOAC group versus 16 (6.7%) within the non-DOAC group. The odds ratio of DOACs usage and evidence of recent thrombus was 2.34 (95% confidence interval: 1.1-5.0, = 0.03) after adjusting for age, gender, race, body mass index, and history of antiphospholipid antibody syndrome. CTEPH patients referred for PEA while on DOAC therapy were twice as likely to have associated acute or subacute thrombi present at the time of surgery compared with those on more traditional, non-DOAC anticoagulant therapies. This raises questions of the safety and efficacy of DOACs in the chronic management of CTEPH.
慢性血栓栓塞性肺动脉高压（CTEPH）患者需要终身抗凝治疗。直接口服抗凝剂（DOAC）在CTEPH慢性期及过渡期治疗中的安全性和有效性尚未得到研究。我们对2015年7月至2017年7月在加利福尼亚大学圣地亚哥分校连续进行的405例肺动脉内膜剥脱术（PEA）病例进行了回顾性分析。由两名对患者信息不知情的研究人员对PEA标本进行检查，以确定是否存在与PEA时预期切除的慢性疾病不同的急性或亚急性血栓物质。在405例PEA病例中，166例患者（41.0%）接受了三种可用DOAC中的一种进行抗凝治疗；239例（59.0%）接受口服维生素K拮抗剂或长期注射治疗。DOAC组和非DOAC组的基线特征无显著差异。DOAC组中有22例（13.3%）观察到近期血栓形成的证据，而非DOAC组中有16例（6.7%）。在调整年龄、性别、种族、体重指数和抗磷脂抗体综合征病史后，DOAC使用与近期血栓形成证据的比值比为2.34（95%置信区间：1.1 - 5.0，P = 0.03）。与接受更传统的非DOAC抗凝治疗的患者相比，接受DOAC治疗的CTEPH患者在接受PEA手术时出现相关急性或亚急性血栓的可能性高出两倍。这引发了关于DOAC在CTEPH慢性管理中的安全性和有效性的问题。
