Pulmonary Arterial Hypertension therapy with anticoagulants is outdated (4)
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Pulmonary Arterial Hypertension therapy with anticoagulants is outdated (4)

September 16, 2019


– Anticoagulants are widely used in clinical
practice in patients with pulmonary arterial hypertension.
Dr. Anton Titov MD But blood thinners, as they are also known,
have a lot of significant side effects. And the major side effect is the risk of bleeding,
including intracranial bleeding, gastrointestinal bleeding. How to balance risks and benefits of anticoagulants
when they are used for pulmonary arterial hypertension? So the whole role of anticoagulants in pulmonary
arterial hypertension is now in question. Originally, anticoagulants were started because
pathologically, when the disease was first described in the 1950s, there was recognition
of what was probably in-situ thrombosis. As such, people start asking questions – if
we have no other treatment options and we put patients on coumadin, will it have an
impact on disease? There was a suggestion that had a small impact
on survival in pulmonary arterial hypertension. Since that time and really over the past five
years, based on studies that have been published out of the European registries, the US registries
and even out of our own patient population here, we’ve recognized that probably there’s
not a lot of clinical benefit, and we’re not convinced anymore that the risks of anticoagulation,
especially lifelong anticoagulation, outweigh the benefit. So for many of us, we’ve actually stopped
using routine anticoagulation. For those patients with pulmonary arterial
hypertension who might have chronic thromboembolic disease, or who have had known blood clots,
obviously they will be anticoagulated. But now less and less we anti-coagulate patients
with pulmonary arterial hypertension, we have no indication that there’s a lot of benefit
from it. – So it also speaks that there’s a lot of
research going on in the vascular lung diseases, and the new medications are becoming available,
and the older ones that were empirically used – they’re being phased out, in a sense. – In many ways, yes…

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