Direct oral anticoagulant use and thrombus detection in patients with chronic thromboembolic pulmonary hypertension referred for pulmonary thromboendarterectomy

Ina Jeong, T. Fernandes, M. Alotaibi, N. Kim
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引用次数: 7

Abstract

Background: Patients with chronic thromboembolic pulmonary hypertension (CTEPH) should be on lifelong, effective anticoagulant therapy. The safety and efficacy of direct oral anticoagulant (DOAC) in CTEPH is unknown. Aim: To evaluate the trend of DOAC usage and correlation with subacute thrombus detection at time of pulmonary thromboendarterectomy. Methods: We performed a retrospective analysis of 405 consecutive pulmonary thromboendarterectomy (PTE) cases at the University of California, San Diego from July 2015 through July 2017. The PTE specimen were reviewed for the presence of acute or subacute thrombotic material removed at the time of PTE. Results: Of 405 consecutive PTE cases, 239 (59.0%) presented on either oral vitamin-K antagonist or chronic injectable therapy; 166 patients (41%) were anticoagulated with DOACs. There were no significant differences in baseline characteristics between DOAC and non-DOAC groups. Evidence of acute or subacute thrombi was observed in 16 (6.7%) within the non-DOAC group versus 22 (13.3%) in the DOAC group. The odds ratio (OR) of DOACs usage and evidence of recent thrombosis was 2.34 (95% CI, 1.09-5.01, p=0.028) after adjusting for age, gender, race, BMI, and history of antiphospholipid antibody syndrome. Conclusions: CTEPH patients referred for PTE while on DOAC therapy were twice as likely to have associated acute or subacute thrombi removed at the time of surgery compared with those on conventional anticoagulant therapies. This raises questions of safety and efficacy of DOACs in the chronic treatment of CTEPH. A formal study of DOACs in the management of CTEPH is indicated.
直接口服抗凝剂使用和血栓检测慢性血栓栓塞性肺动脉高压患者转介肺血栓动脉内膜切除术
背景:慢性血栓栓塞性肺动脉高压(CTEPH)患者应终生接受有效的抗凝治疗。直接口服抗凝剂(DOAC)治疗CTEPH的安全性和有效性尚不清楚。目的:评价肺血栓动脉内膜切除术时DOAC的使用趋势及其与亚急性血栓检测的相关性。方法:我们对2015年7月至2017年7月在加州大学圣地亚哥分校进行的405例连续肺血栓动脉内膜切除术(PTE)进行回顾性分析。结果:405例PTE患者中,239例(59.0%)接受了口服维生素k拮抗剂或慢性注射治疗;166例患者(41%)采用DOACs抗凝治疗。DOAC组和非DOAC组的基线特征无显著差异。非DOAC组有16例(6.7%)患者出现急性或亚急性血栓,DOAC组有22例(13.3%)患者出现血栓。在调整年龄、性别、种族、BMI和抗磷脂抗体综合征史后,DOACs使用与近期血栓形成证据的比值比(OR)为2.34 (95% CI, 1.09-5.01, p=0.028)。结论:与接受常规抗凝治疗的患者相比,接受DOAC治疗的CTEPH患者在手术时清除相关急性或亚急性血栓的可能性是接受常规抗凝治疗的患者的两倍。这就提出了doac在慢性治疗CTEPH中的安全性和有效性问题。建议对DOACs在CTEPH治疗中的作用进行正式研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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