Department of Pulmonary and Critical Care Medicine, Fujian Medical University Union Hospital, Fuzhou, China.
Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Center for Respiratory Medicine, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Science, Beijing, China.
Thromb Res. 2024 Nov;243:109173. doi: 10.1016/j.thromres.2024.109173. Epub 2024 Sep 29.
Anticoagulation was once recommended for patients with pulmonary arterial hypertension (PAH). However, its survival benefit still remained controversial. We performed a meta-analysis to evaluate the effect of anticoagulation on the long-term survival of PAH patients.
The PubMed, EMBASE, Web of Science, and WanFang electronic database were searched for eligible studies. Pooled hazard ratios (HRs) with 95 % confidence intervals (CIs) were calculated for effect estimate regarding anticoagulation on the survival of PAH patients.
Fifteen cohort studies involving 4266 PAH patients were included. Approximately 45.8 % patients received anticoagulation. The mean follow-up period ranged from 2.1 to 14 years. Anticoagulation had a tendency to, however, did not significantly reduce mortality of PAH patients (HR: 0.86, 95 % CI: 0.73-1.02). In subgroup analysis, anticoagulation decreased the mortality risk as analyzed from retrospective studies (HR: 0.80, 95 % CI: 0.65-0.98), but not prospective studies (HR: 0.95, 95 % CI: 0.70-1.29). For both idiopathic PAH (IPAH) and connective tissue disease associated PAH (CTD-PAH), anticoagulation therapy did not significantly improve the long-term survival rate (HR: 0.83, 95 % CI: 0.65-1.07, and HR: 1.05, 95 % CI: 0.77-1.42, respectively), and this result remained unchanged when pooling data from either retrospective or prospective studies. Further analysis showed that anticoagulation had no advantage in reducing mortality in patients with systemic sclerosis associated PAH, systemic erythematosus lupus related PAH (free of antiphospholipid syndrome), or CTD-PAH of non-specified etiology.
Anticoagulation may not reduce the long-term mortality of PAH patients, including those with IPAH and CTD-PAH. In the management of PAH, anticoagulants should be prescribed with caution before comprehensive risk to benefit evaluation. Larger and more vigorously designed controlled trials are warranted.
曾经建议肺高血压（PAH）患者进行抗凝治疗。然而，抗凝治疗对患者生存的获益仍存在争议。我们进行了一项荟萃分析，以评估抗凝治疗对 PAH 患者长期生存的影响。
检索 PubMed、EMBASE、Web of Science 和万方数据库，纳入符合条件的研究。计算合并危险比（HR）及其 95%置信区间（CI），以评估抗凝治疗对 PAH 患者生存的影响。
纳入了 15 项队列研究，共 4266 例 PAH 患者。约 45.8%的患者接受了抗凝治疗。平均随访时间为 2.1 至 14 年。抗凝治疗有降低死亡率的趋势，但无统计学意义（HR：0.86，95%CI：0.73-1.02）。亚组分析显示，回顾性研究中抗凝治疗降低了死亡率风险（HR：0.80，95%CI：0.65-0.98），但前瞻性研究中无此获益（HR：0.95，95%CI：0.70-1.29）。对于特发性 PAH（IPAH）和结缔组织病相关 PAH（CTD-PAH），抗凝治疗并未显著提高长期生存率（HR：0.83，95%CI：0.65-1.07 和 HR：1.05，95%CI：0.77-1.42），无论在回顾性研究还是前瞻性研究中，结果均一致。进一步分析显示，抗凝治疗在系统性硬化症相关 PAH、系统性红斑狼疮相关 PAH（无抗磷脂抗体综合征）或未明确病因的 CTD-PAH 患者中降低死亡率方面并无优势。
抗凝治疗可能无法降低 PAH 患者的长期死亡率，包括 IPAH 和 CTD-PAH 患者。在 PAH 的管理中，应在全面风险获益评估后谨慎使用抗凝剂。需要进行更大规模和更有力设计的对照试验。
