Abstract
Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is one of most prevalent forms of pulmonary hypertension. Differently from other forms, CTEPH is frequently preceded by an acute pulmonary thromboembolic event and, if the patient can undergo a surgical resection (pulmonary thromboendarterectomy (PTE)), there is a possibility of cure for this particular condition. Another mainstay in the treatment of CTEPH is full anticoagulation, maintained indefinitely.
The advent of the new direct oral anticoagulants (DOACs) for the treatment of acute pulmonary embolism has brought a viable and effective alternative for the treatment of this condition in the short and long term; however, little is known about the use of this new class of drugs in CTEPH
The objective of this study was to evaluate the safety and efficacy of DOACs in the treatment of CTEPH.
Methods: Retrospective analysis of a cohort of patients with CTEPH who received treatment with DOACs.
Results: Twenty patients with CTEPH under DOACs were followed for an average 21 months. Sixteen patients used rivaroxaban, three dabigatran and, one apixaban. The mean age was 51years; eighteen of them were in functional class II/III. Eight patients underwent PET, with clinical, hemodynamic and functional improvement and, currently, continue to use DOACs. No episode of VTE recurrence was identified during the follow-up period. Concerning safety, there was one episode of major bleeding after a traumatic fall.
Conclusions: New anticoagulants appear to be a safe and effective alternative in the treatment of CTEPH, although larger studies are needed to ensure their routine use in this situation.
- Copyright ©the authors 2017