Does anticoagulant use improve survival in PAH?

The use of anticoagulant therapy offers no survival benefit in patients with pulmonary arterial hypertension (PAH), a recent study has shown.

A team of investigators conducted a propensity score-based analysis using data from the national French Pulmonary Hypertension Registry. They incorporated their findings into an updated meta-analysis of nationwide datasets.

A total of 1,597 patients diagnosed with PAH between 2009 and 2020 were included in the analysis. Of these, 380 received anticoagulants at diagnosis.

Patients receiving anticoagulants had a median survival of 5.62 years (95 percent confidence interval [CI], 4.76‒6.58), while those who did not receive anticoagulants had a median survival of 5.37 years (95 percent CI, 4.96‒5.82; hazard ratio, 0.997, 95 percent CI, 0.84‒1.18; log-rank test: p=0.97). These findings persisted across all PAH subgroups within the registry.

Similar results were noted in the updated meta-analysis. No significant association was found between anticoagulant use and survival in the overall PAH population (HR, 0.98, 95 percent CI, 0.78‒1.23) and in two subgroups: idiopathic/heritable PAH or PAH associated with anorexigens (HR, 0.99, 95 percent CI, 0.79‒.25) and PAH associated with connective tissue disease (HR, 0.86, 95 percent CI, 0.52‒1.42).

“These results were supported by an updated meta-analysis,” the investigators said. “Randomized controlled trials remain the most reliable approach to definitively assess the therapeutic value of anticoagulation in this population.”