DOAC therapy in CTEPH patients was associated with lower all-cause mortality (30.9% vs 36.8%; P<0.001) and MACE (43.2% vs 46.5%; P<0.001) compared with warfarin.
Cohort (n=16,162)
Yes
Do DOACs reduce mortality and MACE compared to warfarin in adults with chronic thromboembolic pulmonary hypertension?
In a large real-world cohort of patients with CTEPH, DOAC therapy was associated with significantly lower mortality, MACE, and GI bleeding risk compared with warfarin.
Effect estimate: HR 1.29 (95% CI 1.22-1.36)
Absolute Event Rate: 30.9% vs 36.8%
p-value: p=<0.001
Abstract Rationale Long-term anticoagulation is a cornerstone of therapy for chronic thromboembolic pulmonary hypertension (CTEPH). Although direct oral anticoagulants (DOACs) are increasingly used, comparative real-world data on their safety and effectiveness versus warfarin in this population remain limited. Methods We conducted a retrospective, multicenter cohort analysis using the TriNetX U.S. Collaborative Network, comprising electronic health records from 111 healthcare organizations. Adults with CTEPH receiving either warfarin or a DOAC (apixaban or rivaroxaban) were identified. Patients receiving both or switching between anticoagulants were excluded. Propensity score matching (1:1) was performed across demographics, comorbidities, laboratory parameters, and medication profiles, yielding 8,081 matched pairs. Outcomes were assessed beginning 30 days after the index event. Primary endpoints included all-cause mortality and major adverse cardiovascular events (MACE). Secondary endpoints included gastrointestinal (GI) bleeding and hospitalization. Risk differences, odds ratios (OR), and hazard ratios (HR) were derived using TriNetX analytic tools. Results After matching, baseline covariates were balanced (mean age 72.6 ± 15.6 years, 54% female, 70% White). Compared with DOACs, warfarin therapy was associated with higher all-cause mortality (36.8% vs 30.9%; OR 1.30, 95% CI 1.22-1.39; HR 1.29, 95% CI 1.22-1.36; p 0.001) and greater MACE risk (46.5% vs 43.2%; OR 1.14, 95% CI 1.07-1.21; HR 1.15, 95% CI 1.09-1.20; p 0.001). Warfarin users also had a higher incidence of GI bleeding (13.6% vs 12.4%; OR 1.11, 95% CI 1.01-1.21; p = 0.03; HR 1.18, 95% CI 1.08-1.29; p 0.001). Hospitalization rates were similar between groups (2.8% vs 2.4%; p = 0.15). Conclusions In this large real-world cohort of CTEPH patients, DOAC therapy was associated with significantly lower mortality, MACE, and GI bleeding risk compared with warfarin, with comparable hospitalization rates. These findings support the preferential use of DOACs over warfarin for long-term anticoagulation in stable CTEPH, though prospective validation is warranted. This abstract is funded by: None
Chilingarashvili et al. (Fri,) conducted a cohort in chronic thromboembolic pulmonary hypertension (n=16,162). DOACs (apixaban or rivaroxaban) vs. Warfarin was evaluated on all-cause mortality (HR 1.29, 95% CI 1.22-1.36, p=<0.001). DOAC therapy in CTEPH patients was associated with lower all-cause mortality (30.9% vs 36.8%; P<0.001) and MACE (43.2% vs 46.5%; P<0.001) compared with warfarin.
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