What is the role of anticoagulants in the management of pulmonary arterial hypertension (PAH)?

Updated: Apr 25, 2018
  • Author: Kristin E Schwab, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Answer

Anticoagulation (specifically, with warfarin) may be helpful because evidence suggests that patients with idiopathic PAH (IPAH) develop thrombotic arteriopathy (with abnormalities of blood coagulation factors, antithrombotic factors, and the fibrinolytic system). [27] This contributes to a prothrombotic state. In a review of seven observational studies evaluating anticoagulation in IPAH, five demonstrated a mortality benefit. [28] Evidence also suggests a benefit for anticoagulation in patients with hereditary PAH, anorexigen-induced PAH, and pulmonary venoocclusive disease (PVOD). However, evidence in other forms of PAH is lacking, and decisions regarding anticoagulation in these cases should be made on a patient-by-patient basis after weighing the risks and benefits of anticoagulant therapy. Given limited experience with the novel oral anticoagulants such as dabigatran, rivaroxaban, and apixaban in PAH, warfarin remains the anticoagulant of choice. [19]


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