Association Between Anticoagulant Therapy and Survival in Pulmonary Arterial Hypertension: A Registry Report and Updated Meta-Analysis.

BACKGROUND

The role of anticoagulant therapy in the management of pulmonary arterial hypertension (PAH) remains uncertain, as existing epidemiologic studies have produced conflicting results.

OBJECTIVES

The goal of this study was to examine the association between anticoagulant therapy and survival in PAH.

METHODS

A propensity score-based analysis was conducted using data from the national French Pulmonary Hypertension Registry. The findings were then incorporated into an updated meta-analysis of nationwide data sets.

RESULTS

Among the 1,597 patients diagnosed with PAH between 2009 and 2020, a total of 380 received anticoagulants at diagnosis. Median survival was 5.62 years (95% CI: 4.76-6.58) for patients receiving anticoagulants and 5.37 years (95% CI: 4.96-5.82) for those not receiving anticoagulants (HR: 0.997; 95% CI: 0.84-1.18; log-rank test, P = 0.97). Findings were consistent across all PAH subgroups within the registry. The updated meta-analysis yielded similar results, with no statistically significant association between anticoagulant use and survival in the overall PAH population (HR: 0.98; 95% CI: 0.78-1.23), as well as in 2 predefined subgroups: 1) idiopathic/heritable PAH or PAH associated with anorexigens (HR: 0.99; 95% CI: 0.79-1.25); and 2) PAH associated with connective tissue disease (HR: 0.86; 95% CI: 0.52-1.42).

CONCLUSIONS

Anticoagulant use in PAH was not associated with overall survival in the nationwide registry. These results were supported by an updated meta-analysis. Randomized controlled trials remain the most reliable approach to definitively assess the therapeutic value of anticoagulation in this population.