A multicenter study of anticoagulation in operable chronic thromboembolic pulmonary hypertension

Katherine Bunclark, Michael Newnham, Yi-Da Chiu, Alessandro Ruggiero, Sofía S Villar, John E Cannon, Gerry Coghlan, Paul A. Corris, Luke Howard, David Jenkins, Martin Johnson, David G Kiely, Choo Ng, Nicholas Screaton, Karen Sheares, Dolores Taboada, Steven Tsui, S John Wort, Joanna Pepke-Zaba, Mark Toshner

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19 Citations (Scopus)
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Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is an uncommon complication of acute pulmonary emboli necessitating lifelong anticoagulation. Despite this, few data exist on the safety and efficacy of vitamin K antagonists (VKAs) in CTEPH and none for direct oral anticoagulants (DOACs).
Objectives: To evaluate outcomes and complication rates in CTEPH following pulmonary endarterectomy (PEA) for individuals receiving VKAs or DOACs.
Methods: Consecutive CTEPH patients undergoing PEA between 2007 and 2018 were included in a retrospective analysis. Postoperative outcomes, recurrent venous thromboembolism (VTE), and bleeding events were obtained from patient medical records.
Results: Seven hundred ninety‐four individuals were treated with VKAs and 206 with DOACs following PEA. Mean observation period was 612 (standard deviation: 702) days. Significant improvements in hemodynamics and functional status were observed in both groups following PEA (P < .001). Major bleeding events were equivalent (P = 1) in those treated with VKAs (0.67%/person‐year) and DOACs (0.68%/person‐year). The VTE recurrence was proportionately higher (P = .008) with DOACs (4.62%/person‐year) than VKAs (0.76%/person‐year), although survival did not differ.
Conclusions: Post‐PEA functional and hemodynamic outcomes appear unaffected by anticoagulant choice. Bleeding events were similar, but recurrent VTE rates significantly higher in those receiving DOACs. Our study provides a strong rationale for prospective registry data and/or studies to evaluate the safety of DOACs in CTEPH.
Original languageEnglish
Pages (from-to)114-122
Number of pages9
JournalJournal of Thrombosis and Haemostasis
Issue number1
Early online date26 Sept 2019
Publication statusPublished - Jan 2020


  • Anticoagulant
  • Complications
  • Pulmonary hypertension
  • Venous thromboembolism
  • Warfarin


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