Key result
Anticoagulation improves PaO2 by ~12 mmHg in IPF but fails to reduce mortality.
Why the study?
IPF patients frequently exhibit a hypercoagulable state, making anticoagulant therapy a potential strategy, but its clinical utility remains controversial.
Does anticoagulant therapy improve clinical outcomes and is it safe in patients with idiopathic pulmonary fibrosis?
Meta-Analysis (n=504)
Does anticoagulant therapy improve clinical outcomes and is it safe in patients with idiopathic pulmonary fibrosis?
Mean Difference: 11.64 (95% CI 7.09–16.18)
p-value: p=<0.00001
Although anticoagulant therapy may improve oxygenation parameters in patients with idiopathic pulmonary fibrosis, it is associated with a significant increase in all-cause mortality and adverse reactions, suggesting it should not be routinely used.
May increase mortality and harms in IPF despite oxygenation gains; leaves open specific-agent effects for larger RCTs.
Background: Therapeutic management of idiopathic pulmonary fibrosis (IPF) remains challenging. IPF patients frequently exhibit a hypercoagulable state, and anticoagulant therapy has emerged as a potential strategy; however, its clinical utility remains controversial. Objectives: To systematically evaluate the efficacy and safety of anticoagulant therapy in IPF patients. Design: Systematic review and meta-analysis of randomised controlled trials. Data sources and methods: Comprehensive searches were conducted in PubMed, Cochrane Library, EMBASE, Web of Science, CNKI, Wanfang Data, VIP, and CBM databases for randomised controlled trials (RCTs) investigating anticoagulant therapy in IPF, from database inception to February 2025. Two investigators independently screened the literature, extracted data, and assessed risk of bias. Meta-analysis was performed using RevMan 5.3. Results: Seven RCTs involving 504 patients with IPF were included. Compared with control groups not receiving anticoagulants, anticoagulant therapy significantly improved PaO 2 (MD = 11.64, 95% CI 7.09–16.18, p < 0.00001), SaO 2 (MD = 4.44, 95% CI 2.42–6.47, p < 0.0001), and HGF levels (MD = 108.74, 95% CI 88.58 to 128.90, p < 0.00001) but significantly reduced the mMRC score (MD = −0.38, 95% CI −0.62 to −0.14, p = 0.002) and D-dimer levels (MD = -0.08, 95% CI −0.11 to −0.05, p < 0.00001). No significant difference was observed in PaCO 2 levels (MD = −4.26, 95% CI −9.09 to 0.56, p = 0.08). Anticoagulant therapy did not demonstrate benefit in reducing all-cause mortality (RR = 3.46, 95% CI 1.57–7.61, p = 0.002) or adverse reactions (MD = 1.44, 95% CI 1.15–1.81, p = 0.002). Conclusion: Anticoagulant therapy may offer clinical benefits in IPF management. However, its lack of mortality benefit and safety concerns warrant cautious interpretation. Clinicians should carefully assess individual bleeding risks before initiating treatment. Due to the limited number of included studies and data constraints, further large-scale, high-quality, multicenter, and long-term RCTs are needed. Future research should prioritise risk stratification, optimised anticoagulation protocols and identification of biomarkers predictive of bleeding risk to inform clinical decision-making. Trial registration: The study protocol was registered with PROSPERO (Registration number: CRD42022349940).
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Zhao et al. (2025) conducted a meta-analysis in Idiopathic pulmonary fibrosis (n=504). Anticoagulant therapy vs. Standard care, placebo, or no intervention was evaluated on PaO2 (MD 11.64, 95% CI 7.09-16.18, p=<0.00001). Anticoagulant therapy significantly improved PaO2 (MD 11.64) and SaO2 (MD 4.44) in patients with idiopathic pulmonary fibrosis, but did not reduce all-cause mortality (RR 3.46) and increased adverse events.
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