Association Between Anticoagulant Therapy and Survival in Pulmonary Arterial Hypertension: A Registry Report and Updated Meta-Analysis.

Abstract

Background: The role of anticoagulant therapy in the management of pulmonary arterial hypertension (PAH) remains uncertain, as existing epidemiologic studies have produced conflicting results.

Objectives: The goal of this study was to examine the association between anticoagulant therapy and survival in PAH.

Methods: A propensity score-based analysis was conducted using data from the national French Pulmonary Hypertension Registry. The findings were then incorporated into an updated meta-analysis of nationwide data sets.

Results: Among the 1,597 patients diagnosed with PAH between 2009 and 2020, a total of 380 received anticoagulants at diagnosis. Median survival was 5.62 years (95% CI: 4.76-6.58) for patients receiving anticoagulants and 5.37 years (95% CI: 4.96-5.82) for those not receiving anticoagulants (HR: 0.997; 95% CI: 0.84-1.18; log-rank test, P = 0.97). Findings were consistent across all PAH subgroups within the registry. The updated meta-analysis yielded similar results, with no statistically significant association between anticoagulant use and survival in the overall PAH population (HR: 0.98; 95% CI: 0.78-1.23), as well as in 2 predefined subgroups: 1) idiopathic/heritable PAH or PAH associated with anorexigens (HR: 0.99; 95% CI: 0.79-1.25); and 2) PAH associated with connective tissue disease (HR: 0.86; 95% CI: 0.52-1.42).

Conclusions: Anticoagulant use in PAH was not associated with overall survival in the nationwide registry. These results were supported by an updated meta-analysis. Randomized controlled trials remain the most reliable approach to definitively assess the therapeutic value of anticoagulation in this population.