Oral Sildenafil Helpful in Inoperable Chronic Thromboembolic Pulmonary Hypertension

Laurie Barclay, MD

April 23, 2003

April 23, 2003 -- Oral sildenafil may offer a viable alternative to surgery for people with inoperable chronic thromboembolic pulmonary hypertension, according to the results of a small prospective study reported in the April 15 issue of the American Journal of Respiratory and Critical Care Medicine.

"Only a small percentage of patients with chronic thromboembolic pulmonary hypertension are eligible for pulmonary thrombendarterectomy," write Hossein A. Ghofrani and colleagues from the University of Giessen in Germany. "Oral sildenafil may offer a new option for medical treatment of this devastating disease."

The 12 patients enrolled in this study had progressive disease despite sufficient long-term anticoagulation and the best supportive care. None of the patients were operative candidates, and all had severe pulmonary hypertension. Pulmonary vascular resistance index was 1,935 ± 228 dyn·s·cm-5·m2, cardiac index was 2.0 L/min/m2, and six-minute walking distance was 312 ± 30 m.

After approximately six months of treatment with sildenafil, pulmonary hemodynamics and exercise capacity improved significantly. Pulmonary vascular resistance index improved to 1,361 ± 177 dyn·s·cm-5·m2 (P = .004), cardiac index to 2.4 ± 0.2 L/min/m 2 ( P = .009), and six-minute walking distance to 366 ± 28 m ( P = .02).

"Although limited by the lack of a control group, long-term treatment with the oral phosphodiesterase-5 inhibitor sildenafil caused a significant improvement of pulmonary hemodynamics and exercise capacity in patients with severe nonoperable chronic thromboembolic pulmonary hypertension," the authors write, while recommending a randomized, placebo-controlled multicenter study. "It will be of interest to see whether the impressive effects seen with sildenafil could be obtained also with other vasodilators."

Am J Respir Crit Care Med. 2003;167:1139-1141

Reviewed by Gary D. Vogin, MD

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