Jain Hritvik, Odat Ramez M, Ahmed Mushood, Jain Jyoti, Goyal Aman, Idrees Muhammad, Passey Siddhant, Jha Jagriti, Shah Janhvi, Gole Shrey
From the Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India.
Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
Cardiol Rev. 2024 Jun 4. doi: 10.1097/CRD.0000000000000735.
Chronic thromboembolic pulmonary hypertension (CTEPH) is a subtype of pulmonary hypertension characterized by organized thrombi inside the pulmonary vasculature, leading to an increase in pulmonary artery pressure. CTEPH is seen in about 3-4% of patients with acute pulmonary embolism and is associated with poor outcomes. Apart from surgical intervention, lifelong anticoagulation is the mainstay of CTEPH management. Traditionally, CTEPH is managed with vitamin-K antagonists (VKA); however, direct oral anticoagulants (DOACs) are recently gaining popularity. However, the current literature comparing DOACs versus VKAs in CTEPH has inconsistent results. An electronic search of the major bibliographic databases was performed to retrieve studies comparing DOACs versus VKAs in CTEPH patients. For dichotomous outcomes, the odds ratio (ORs) with 95% confidence intervals (CI) were pooled using the DerSimonian and Laird random-effects model to generate forest plots. Statistical significance was considered at P < 0.05. Ten studies were included with 3936 patients (1269 in the DOAC group and 2667 in the VKA group). Treatment with DOAC was associated with no statistically significant difference in the risk of all-cause mortality (OR, 0.78; 95% CI, 0.35-1.71; P < 0.53), venous thromboembolism (OR, 1.19; 95% CI, 0.59-2.40; P = 0.63), major bleeding (OR, 0.68; 95% CI, 0.38-1.22; P = 0.20), and clinically relevant nonmajor bleeding (OR, 1.22; 95% CI, 0.80-1.86; P = 0.37). Our analysis demonstrates that DOACs are noninferior to VKAs in terms of their safety and outcomes profile in CTEPH. Further trials are needed to evaluate more robust evidence and to compare additional outcomes.
慢性血栓栓塞性肺动脉高压（CTEPH）是肺动脉高压的一种亚型，其特征是肺血管内有组织化血栓形成，导致肺动脉压力升高。CTEPH见于约3%-4%的急性肺栓塞患者，且与不良预后相关。除手术干预外，终身抗凝是CTEPH治疗的主要手段。传统上，CTEPH采用维生素K拮抗剂（VKA）治疗；然而，直接口服抗凝剂（DOAC）近来越来越受欢迎。然而，目前比较CTEPH患者中DOAC与VKA的文献结果并不一致。我们对主要文献数据库进行了电子检索，以获取比较CTEPH患者中DOAC与VKA的研究。对于二分法结局，采用DerSimonian和Laird随机效应模型汇总具有95%置信区间（CI）的比值比（OR），以生成森林图。P<0.05被视为具有统计学意义。纳入了10项研究，共3936例患者（DOAC组1269例，VKA组2667例）。DOAC治疗在全因死亡率风险（OR，0.78；95%CI，0.35-1.71；P<0.53）、静脉血栓栓塞（OR，1.19；95%CI，0.59-2.40；P=0.63）、大出血（OR，0.68；95%CI，0.38-1.22；P=0.20）和临床相关非大出血（OR，1.22；95%CI，0.80-1.86；P=0.37）方面无统计学显著差异。我们的分析表明，在CTEPH患者中，DOAC在安全性和结局方面不劣于VKA。需要进一步的试验来评估更有力的证据，并比较其他结局。
