PMID- 28643420
OWN - NLM
STAT- MEDLINE
DCOM- 20180521
LR  - 20220419
IS  - 1755-5922 (Electronic)
IS  - 1755-5914 (Print)
IS  - 1755-5914 (Linking)
VI  - 35
IP  - 5
DP  - 2017 Oct
TI  - Impact on survival of warfarin in patients with pulmonary arterial hypertension 
      receiving subcutaneous treprostinil.
LID - 10.1111/1755-5922.12281 [doi]
AB  - INTRODUCTION: Anticoagulation is a common treatment modality in patients with 
      pulmonary arterial hypertension (PAH). Further studies are needed to 
      appropriately assess the risk/benefit ratio of anticoagulation, particularly in 
      PAH patients receiving PAH-specific therapies. AIMS: We use observational 
      long-term data on PAH patients treated with subcutaneous (SQ) treprostinil from a 
      large open-label study. Patients were followed for up to 4 years. The use of 
      warfarin and bleeding events were recorded. RESULTS: At total of 860 patients 
      (age [mean+/-SD] 46+/-15 years, 76% female, 83% Caucasian, 49% idiopathic PAH, and 
      76% New York Heart Association [NYHA] functional class III) were included. All 
      patients received SQ treprostinil (15% also other pulmonary hypertension 
      [PH]-therapies) and 590 (69%) received warfarin during the study. The proportions 
      of women, African American, and idiopathic pulmonary hypertension (IPAH) patients 
      were higher in the group receiving warfarin. A higher proportion of patients with 
      congenital heart disease and portopulmonary hypertension did not receive 
      warfarin. There were no differences in unadjusted long-term survival between PAH 
      patients receiving warfarin or not (log-rank test, P value=.69), even when only 
      considering idiopathic PAH (P=.32). In addition, no difference was found in 
      adjusted long-term survival both in PAH (P=.84) and idiopathic PAH patients 
      (P=.44) based on the use of warfarin. Furthermore, no survival difference based 
      on the use of warfarin were noted between propensity score-matched PAH patients 
      (P=.37). CONCLUSIONS: Long-term anticoagulation with warfarin was not associated 
      with any significant effect on survival in PAH or idiopathic PAH patients treated 
      with SQ treprostinil.
CI  - (c) 2017 John Wiley & Sons Ltd.
FAU - Ascha, Mona
AU  - Ascha M
AUID- ORCID: 0000-0003-1807-4465
AD  - Case Western Reserve University School of Medicine, Cleveland, OH, USA.
FAU - Zhou, Xuan
AU  - Zhou X
AD  - United Therapeutics Corporation, Research Triangle Park, NC, USA.
FAU - Rao, Youlan
AU  - Rao Y
AD  - United Therapeutics Corporation, Research Triangle Park, NC, USA.
FAU - Minai, Omar A
AU  - Minai OA
AD  - Pulmonary and Critical Care, Southside Regional Medical Center, Petersburg, VA, 
      USA.
FAU - Tonelli, Adriano R
AU  - Tonelli AR
AD  - Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory 
      Institute, Cleveland Clinic, Cleveland, OH, USA.
LA  - eng
GR  - KL2 TR000440/TR/NCATS NIH HHS/United States
GR  - R01 HL130307/HL/NHLBI NIH HHS/United States
GR  - UL1 TR000439/TR/NCATS NIH HHS/United States
PT  - Comparative Study
PT  - Journal Article
PT  - Observational Study
PL  - England
TA  - Cardiovasc Ther
JT  - Cardiovascular therapeutics
JID - 101319630
RN  - 0 (Anticoagulants)
RN  - 0 (Antihypertensive Agents)
RN  - 5Q7ZVV76EI (Warfarin)
RN  - DCR9Z582X0 (Epoprostenol)
RN  - RUM6K67ESG (treprostinil)
SB  - IM
MH  - Adult
MH  - Anticoagulants/adverse effects/*therapeutic use
MH  - Antihypertensive Agents/adverse effects/*therapeutic use
MH  - Chi-Square Distribution
MH  - Epoprostenol/adverse effects/*analogs & derivatives/therapeutic use
MH  - Familial Primary Pulmonary Hypertension/diagnosis/*drug 
      therapy/mortality/physiopathology
MH  - Female
MH  - Hemorrhage/chemically induced
MH  - Humans
MH  - Infusions, Subcutaneous
MH  - Kaplan-Meier Estimate
MH  - Male
MH  - Middle Aged
MH  - Propensity Score
MH  - Proportional Hazards Models
MH  - Risk Assessment
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
MH  - Warfarin/adverse effects/*therapeutic use
PMC - PMC5600501
MID - NIHMS904675
OTO - NOTNLM
OT  - Anticoagulation
OT  - Pulmonary arterial hypertension
OT  - Survival
OT  - Treprostinil
OT  - Warfarin
COIS- Conflict of interest statements: Mona Ascha BS: The author has no significant 
      conflicts of interest with any companies or organization whose products or 
      services may be discussed in this article. Xuan Zhou MS: The author is an 
      employee of United Therapeutics, the company who conducted and analyzed these 
      clinical trials. Youlan Rao PhD: The author is an employee of United 
      Therapeutics, the company who conducted and analyzed these clinical trials. Omar 
      A. Minai MD: The author is a member of the scientific advisory board of Actelion, 
      Gilead, and Bayer and a member of the speakers bureau of Actelion, Gilead, United 
      Therapeutics, and Bayer. Adriano R. Tonelli MD: The author has no significant 
      conflicts of interest with any companies or organization whose products or 
      services may be discussed in this article.
EDAT- 2017/06/24 06:00
MHDA- 2018/05/22 06:00
PMCR- 2018/10/01
CRDT- 2017/06/24 06:00
PHST- 2017/03/24 00:00 [received]
PHST- 2017/06/15 00:00 [revised]
PHST- 2017/06/19 00:00 [accepted]
PHST- 2017/06/24 06:00 [pubmed]
PHST- 2018/05/22 06:00 [medline]
PHST- 2017/06/24 06:00 [entrez]
PHST- 2018/10/01 00:00 [pmc-release]
AID - 10.1111/1755-5922.12281 [doi]
PST - ppublish
SO  - Cardiovasc Ther. 2017 Oct;35(5):10.1111/1755-5922.12281. doi: 
      10.1111/1755-5922.12281.