PB0477 - Safety and efficacy of direct oral anticoagulants in patients with chronic thromboembolic pulmonary hypertension

Sunday, June 25, 2023

18:30 – 19:30 ET

Room: Exhibition

Presenting Author(s)

Ilham Benzidia, MD

CHU Réunion - France
Saint Denis, France

Co-Author(s)

CR

Chantal Robitaille

PhD
Jewish General Hospital - McGill University
Montreal, Quebec, Canada
AA

Ali Abualsaud

MD
Jewish General Hospital - McGill University
Montreal, Quebec, Canada
LM

Laura McDonald

MD
Jewish General Hospital - McGill University
Montreal, Quebec, Canada
LL

Lyda Lesenko

RN
Jewish General Hospital - McGill University
Montreal, Quebec, Canada
JM

Jean-François Morin

MD
Jewish General Hospital - McGill University
Montreal, Quebec, Canada
DL

David Langleben

MD
Jewish General Hospital - McGill University
Montreal, Quebec, Canada
SK

Susan R. Kahn

MD, MSc
McGill University, Montreal, QC, Canada
Montreal, Quebec, Canada
AH

Andrew Hirsch

MD
Jewish General Hospital - McGill University
Montreal, Quebec, Canada

Background: Chronic thromboembolic pulmonary hypertension (CTEPH) remains an underdiagnosed disease. Anticoagulation is essential in its therapy to prevent recurrent venous thromboembolism (VTE). However, in CTEPH there is limited data available on the safety and use of DOAC, and the available data are somewhat conflicting. According to some international guidelines, vitamin K antagonists (VKA) remain the gold standard. In practice, many patients with CTEPH are treated with DOAC from the time of their initial diagnosis or are transitioned from VKA to DOAC, and that has increasingly been the experience at the CTEPH clinic at our center.

Aims: The objective of this study was to determine if DOAC is an effective and safe alternative to VKA in CTEPH patients.

Methods: A retrospective observational study was conducted between 1986 and 2021 in a CTEPH Clinic of a tertiary care hospital. We recorded demographic characteristics, anticoagulant therapies and pulmonary hypertension treatments received. Safety outcomes were bleeding events and deaths while efficacy outcomes were recurrent VTE events.

Results: Among the study population (N=205), the distribution of anticoagulant used transitioned from majority on VKA to majority on DOAC. In 2020, 19% were on VKA and 78% on DOAC. Among 13 VTE events occurring during follow-up, 9 were in the VKA group (1.23%/person-year) and 1 in the DOAC group (0.31%/person-year). Rates of VTE recurrence were not significantly different in those treated with DOAC compared to VKA (P=0.16). Total bleeding rate on VKA (2.19%/person-year) and DOAC (2.51%/person-year) did not differ significantly (P=0.75). Among 44 patients who died, no deaths occurred as a consequence of bleeding or VTE events.

Conclusion(s): Bleeding and VTE events were not higher in CTEPH patients receiving DOAC compared to VKA which adds confidence to considering DOAC as an effective and safe alternative for long term anticoagulation in CTEPH patients.