ANTICOAGULATION AND SURVIVAL IN PULMONARY ARTERIAL HYPERTENSION: RESULTS FROM THE COMPARITIVE, PROSPECTIVE REGISTRY OF NEWLY INITIATED THERAPIES FOR PULMONARY ARTERIAL HYPERTENSION (COMPERA) (Olsson et al, Circulation 2014; 129 (1):57 – 65)

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This study assessed the impact of anticoagulation on survival in patients with pulmonary arterial hypertension (PAH), both idiopathic (IPAH) & associated (APAH). It was a prospective European registry, which included 1283 patients; 62% of which had IPAH, the remainder had APAH.  56% received anticoagulation at any time during follow up, the majority receiving warfarin.  In those with IPAH, estimated survival at 1, 2 & 3 years was 95%, 87% & 77% in those anticoagulated, as compared to 91%, 81% & 66% in those who were not (p 0.006).  Those who received anticoagulation had worse haemodynamics at baseline & were more likely to receive combination therapy.  Matched-paired analysis was performed to account for these differences & the significant results persisted.  Anticoagulation use was associated with improved survival of IPAH patients (HR 0.79).  This survival benefit was not seen in APAH.

Summary: Anticoagulation improves survival in IPAH only.  A RCT is needed to definitively address anticoagulation as a treatment for PAH.