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Letter by Bertoletti et al Regarding Article, “Anticoagulation and Survival in Pulmonary Arterial Hypertension: Results From the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA)”

2014; Lippincott Williams & Wilkins; Volume: 130; Issue: 12 Linguagem: Inglês

10.1161/circulationaha.113.007143

1524-4539

Laurent Bertoletti, Patrick Mismetti, Hervé Decousus,

Interstitial Lung Diseases and Idiopathic Pulmonary Fibrosis

HomeCirculationVol. 130, No. 12Letter by Bertoletti et al Regarding Article, "Anticoagulation and Survival in Pulmonary Arterial Hypertension: Results From the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA)" Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBLetter by Bertoletti et al Regarding Article, "Anticoagulation and Survival in Pulmonary Arterial Hypertension: Results From the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA)" Laurent Bertoletti, MD, , PhD, Patrick Mismetti, MD, PhD and Hervé Decousus, MD, PhD Laurent BertolettiLaurent Bertoletti Université Jean-Monnet, Thrombosis Research Group, St. Etienne, France, INSERM, CIC-CIE3, St. Etienne, France, Centre Hospitalier Universitaire, Service de Médecine Vasculaire et Thérapeutique, St. Etienne, France , Patrick MismettiPatrick Mismetti Université Jean-Monnet, Thrombosis Research Group, St. Etienne, France, INSERM, CIC-CIE3, St. Etienne, France, Centre Hospitalier Universitaire, Service de Médecine Vasculaire et Thérapeutique, St. Etienne, France and Hervé DecoususHervé Decousus Université Jean-Monnet, Thrombosis Research Group, St. Etienne, France, INSERM, CIC-CIE3, St. Etienne, France, Centre Hospitalier Universitaire, Service de Médecine Vasculaire et Thérapeutique, St. Etienne, France Originally published16 Sep 2014https://doi.org/10.1161/CIRCULATIONAHA.113.007143Circulation. 2014;130:e108To the Editor:Olsson and coworkers1 have to be warmly thanked for their important work on the debatable question of anticoagulant therapy in patients with pulmonary arterial hypertension (PAH).They make the paradox of anticoagulation for PAH patients quite apparent. Clinicians are making huge efforts to evaluate targeted therapies in well-designed, randomized, controlled trials, yet at the same time, we are prescribing potentially life-threatening drugs such as vitamin K antagonists (VKA), which are recommended with a low level of evidence2 but prescribed widely in clinical practice.3In their study, Olsson et al found that VKA prescription was associated with a better prognosis in patients with idiopathic PAH. However, the potential impact of VKA on prognosis merely depends on their expected effect. In others words, it depends on their indication. VKAs are the cornerstone therapy in venous thromboembolism (VTE), as in atrial fibrillation (AF). They are associated with a reduction in mortality compared with placebo in both indications.4 It is worth noting that VTE and AF increase frequently after 60 years of age. Because the median age in the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA) study was 70 years in the anticoagulant group, it is possible that a significant proportion of patients were also experiencing VTE or AF. It would therefore be important first to know whether VKAs were prescribed for a validated indication such as VTE or AF and second to evaluate whether their benefit remains according to the presence or absence of such an indication.If data limited to patients with PAH but without validated indications for VKA remain favorable to VKA therapy in PAH patients, it would then be timely to evaluate the risk-to-benefit ratio of antithrombotic therapy in patients with PAH. In line with this last point, it would be important to evaluate the pharmacological interactions between new oral anticoagulants (indicated for VTE and AF) and the treatment received by patients with PAH.5Laurent Bertoletti, MD, PhDPatrick Mismetti, MD, PhDHervé Decousus, MD, PhDUniversité Jean-MonnetThrombosis Research GroupSt. Etienne, FranceINSERM, CIC-CIE3St. Etienne, FranceCentre Hospitalier UniversitaireService de Médecine Vasculaire et ThérapeutiqueSt. Etienne, FranceDisclosuresNone.References1. Olsson KM, Delcroix M, Ghofrani HA, Tiede H, Huscher D, Speich R, Grünig E, Staehler G, Rosenkranz S, Halank M, Held M, Lange TJ, Behr J, Klose H, Claussen M, Ewert R, Opitz CF, Vizza CD, Scelsi L, Vonk-Noordegraaf A, Kaemmerer H, Gibbs JS, Coghlan G, Pepke-Zaba J, Schulz U, Gorenflo M, Pittrow D, Hoeper MM. Anticoagulation and survival in pulmonary arterial hypertension: results from the Comparative, Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension (COMPERA).Circulation. 2014; 129:57–65.LinkGoogle Scholar2. Galiè N, Hoeper MM, Humbert M, Torbicki A, Vachiery J-L, Barbera J a, Beghetti M, Corris P, Gaine S, Gibbs JS, Gomez-Sanchez MA, Jondeau G, Klepetko W, Opitz C, Peacock A, Rubin L, Zellweger M, Simonneau G. Guidelines for the diagnosis and treatment of pulmonary hypertension.Eur Respir J. 2009; 34:1219–1263.CrossrefMedlineGoogle Scholar3. Humbert M, Sitbon O, Chaouat A, Bertocchi M, Habib G, Gressin V, Yaïci A, Weitzenblum E, Cordier JF, Chabot F, Dromer C, Pison C, Reynaud-Gaubert M, Haloun A, Laurent M, Hachulla E, Cottin V, Degano B, Jaïs X, Montani D, Souza R, Simonneau G. Survival in patients with idiopathic, familial, and anorexigen-associated pulmonary arterial hypertension in the modern management era.Circulation. 2010; 122:156–163.LinkGoogle Scholar4. BAATAF Investigators. The effect of low-dose warfarin on the risk of stroke in patients with nonrheumatic atrial fibrillation: the Boston Area Anticoagulation Trial for Atrial Fibrillation Investigators.N. Engl. J. Med. 1990; 323:1505–1511.CrossrefMedlineGoogle Scholar5. Bertoletti L, Delavenne X, Montani D. Antithrombotics in pulmonary hypertension: more work needed before we turn to newer agents!Eur Respir J. 2013; 41:775–777.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Margelidon-Cozzolino V, Delavenne X, Catella-Chatron J, De Magalhaes E, Bezzeghoud S, Humbert M, Montani D and Bertoletti L (2019) Indications and potential pitfalls of anticoagulants in pulmonary hypertension: Would DOACs become a better option than VKAs?, Blood Reviews, 10.1016/j.blre.2019.05.003, 37, (100579), Online publication date: 1-Sep-2019. Parthvi R, Sikachi R, Agrawal A, Adial A, Vulisha A, Khanijo S and Talwar A (2017) Pulmonary hypertension associated with antiphospholipid antibody: Call for a screening tool?, Intractable & Rare Diseases Research, 10.5582/irdr.2017.01044, 6:3, (163-171), . Gabriel L, Delavenne X, Bedouch P, Khouatra C, Bouvaist H, Cordier J, Mornex J, Pison C, Cottin V and Bertoletti L (2016) Risk of Direct Oral Anticoagulant Bioaccumulation in Patients with Pulmonary Hypertension, Respiration, 10.1159/000445122, 91:4, (307-315), . Matsuzaki T, Araki R and Minamino T (2015) Drug Delivery System, a Promising Therapeutic Strategy for Acute Myocardial Infarction, Drug Delivery System, 10.2745/dds.30.276, 30:4, (276-285), . Messina C, Arakaki J and Ferreira E (2014) Tratamento da HAP com enfoque nas doenças reumáticas, Revista Paulista de Reumatologia, 10.46833/reumatologiasp.2014.13.2.36-43:2014 abr-jun;13(2), (36-43) September 16, 2014Vol 130, Issue 12 Advertisement Article InformationMetrics © 2014 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.113.007143PMID: 25223778 Originally publishedSeptember 16, 2014 PDF download Advertisement SubjectsAnticoagulantsEpidemiology