Laviola Domenico, Manzi Giovanna, Recchioni Tommaso, Luise Maria Cristina, Mercurio Valentina, Mihai Alexandra, Badagliacca Roberto, Papa Silvia, Vizza Carmine Dario
Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Policlinico Universitario Umberto I, Sapienza University of Rome, 00161 Rome, Italy.
Department of Translational Medical Sciences, Federico II University of Naples, 80138 Naples, Italy.
J Cardiovasc Dev Dis. 2025 Jul 16;12(7):271. doi: 10.3390/jcdd12070271.
Chronic thromboembolic pulmonary hypertension (CTEPH) can complicate the clinical course of patients with acute pulmonary embolism, with a variable prevalence of 0.5-4%. Beyond specific therapeutic strategies, including pulmonary endarterectomy, balloon pulmonary angioplasty and pulmonary vasodilators, lifelong anticoagulation still represents the mainstay of treatment for this condition. The main historical experience supports the use of vitamin K antagonists (VKAs) in CTEPH patients; conversely, the efficacy and safety of direct oral anticoagulants (DOACs) in this setting are unclear. Growing experience, mainly from small studies and registries, is improving our knowledge, showing that DOACs may represent a valid and promising alternative to warfarin in CTEPH patients. Therefore, in the management of cases with a newly diagnosed CTEPH, clinicians are very often in the difficult position of (a) having to choose which anticoagulant to initiate in anticoagulant-naïve patients or (b) having to evaluate whether it is necessary to switch to a VKA in patients already on DOACs. This article aims to critically summarize the current evidence comparing DOACs and VKAs in CTEPH, discussing their efficacy and safety profiles and exploring their clinical applicability.
慢性血栓栓塞性肺动脉高压（CTEPH）可使急性肺栓塞患者的临床病程复杂化，其患病率在0.5%至4%之间不等。除了包括肺动脉内膜剥脱术、球囊肺动脉成形术和肺血管扩张剂在内的特定治疗策略外，终身抗凝仍是这种疾病治疗的主要支柱。主要的历史经验支持在CTEPH患者中使用维生素K拮抗剂（VKA）；相反，直接口服抗凝剂（DOAC）在这种情况下的疗效和安全性尚不清楚。越来越多的经验，主要来自小型研究和登记处，正在增进我们的了解，表明DOAC在CTEPH患者中可能是华法林的一种有效且有前景的替代药物。因此，在管理新诊断的CTEPH病例时，临床医生常常处于两难境地：（a）必须选择在未接受过抗凝治疗的患者中开始使用哪种抗凝剂，或者（b）必须评估在已经使用DOAC的患者中是否有必要改用VKA。本文旨在批判性地总结目前比较CTEPH中DOAC和VKA的证据，讨论它们的疗效和安全性概况，并探讨它们的临床适用性。
