1. Major bleeding with vitamin K antagonist anticoagulants in pulmonary hypertension.
- Author
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Henkens IR, Hazenoot T, Boonstra A, Huisman MV, and Vonk-Noordegraaf A
- Subjects
- Administration, Oral, Adult, Aged, Disease-Free Survival, Female, Fibrinolytic Agents therapeutic use, Humans, Hypertension, Pulmonary complications, International Normalized Ratio, Male, Middle Aged, Platelet Count, Retrospective Studies, Anticoagulants adverse effects, Hemorrhage chemically induced, Hypertension, Pulmonary drug therapy, Vitamin K antagonists & inhibitors
- Abstract
Vitamin K antagonists are advised in pulmonary arterial hypertension patients despite a lack of safety data. We reviewed major bleeding in three classes of pulmonary hypertension patients, all receiving vitamin K antagonists. Bleeding event rates were 5.4 per 100 patient-years for patients with idiopathic pulmonary arterial hypertension, 19 per 100 patient-years for connective tissue disease related pulmonary arterial hypertension patients and 2.4 per 100 patient-years for chronic thromboembolic pulmonary hypertension patients. Life tables analysis showed that event-free survival was worse in patients with connective tissue disease related pulmonary hypertension than in patients with idiopathic pulmonary arterial hypertension (Wilcoxon=12.8; p<0.001), and patients with chronic thromboembolic pulmonary hypertension (Wilcoxon=23.2; p<0.001). Patients with idiopathic pulmonary arterial hypertension suffered more events than patients with chronic thromboembolic pulmonary hypertension (Wilcoxon=7.2; p<0.01). Major bleeding was independent of age, sex, target international normalised ratio (INR) range, documented INR, vitamin K antagonist type, or right atrial pressure, but was associated with use of prostacyclin analogues. Major bleeding risk during vitamin K antagonist therapy differs among groups of patients with pulmonary hypertension. Further research regarding optimal anticoagulant therapy is needed, as well as risk-benefit analyses for pulmonary hypertension patients with a higher bleeding propensity.
- Published
- 2013
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