VTE recurrence in chronic thromboembolic pulmonary hypertension higher with DOACs vs warfarin

For patients with chronic thromboembolic pulmonary hypertension (CTEPH) receiving anticoagulation treatment, direct oral anticoagulants (DOACs) appear to yield similar survival and bleeding outcomes but higher risk of venous thromboembolism (VTE) recurrence compared with warfarin, according to a study.

For the study, researchers looked at patients who were first diagnosed with CTEPH in Fuwai Hospital in China and initiated on long-term anticoagulation treatment with warfarin or DOACs. All patients were followed up until death, transition to other kinds of anticoagulants, or discontinuation of anticoagulation.

Propensity score matching was performed to balance confounding bias of baseline characteristics among patients. The study outcomes were all-cause death, major bleeding, clinically relevant nonmajor bleeding, and VTE recurrence.

The analysis included 115 patients taking warfarin and 206 matched patients taking DOACs. Over a median follow up of 5.5 years, survival did not significantly differ between the warfarin and the DOAC groups (p=0.77). The same was true for the rates of major bleeding (0.3 percent vs 0.4 percent per person-year, respectively; p=0.705) and clinically relevant nonmajor bleeding (3.1 percent vs 3.2 percent per person-year, respectively; p>0.999).

However, the rate of VTE recurrence was significantly higher in the DOAC group (1.5 percent vs 0.3 percent per person-year; p=0.030).