Chronic Thromboembolic Pulmonary Hypertension (CTEPH) is the combination of initial occlusion of the proximal major vessels by embolic material and its damage as a arteriopathy and microvascular disease on the distal part of the lesion. Lifelong anticoagulation is recommended on CTEPH. There is no data of efficacy and safety of new oral anticoagulants(NOAC) on CTEPH. The aim of this study was to evaluate the rate of NOAC maintanence , bleeding and venous thrombosis recurrence.
We reviewed the medical records of 425 patients. Mean age of the 425 patients was 53,91± 15,00 years, 52,5 % were females. Right heart catheterization data was observed as followed;mean pulmonary artery pressure , pulmonary vascular resistance, cardiac index , wedge pressure were 46,82±14,70 mmHg, 9,05±5,27 Wood units, 2,46±0,98 L/min/m2 ,10,87±2,92 mmHg respectively, at the time of diagnosis. 78 patients (18,4%) has died during follow-up.The underlying reasons of death distribution was as followed; postop mortality, re-embolism, congestive heart failure, myocardial infarction, bleeding, respiratory failure 36 patients (8,5%);3 (0,7%);24 (5,6%);2 (0,5%);9 (2,1%);7 (1,6%) respectively (Figure-1). 337 patients (79,2%) discharged with warfarin initially. 39,4% of this population has switched their anti-coagulant therapy for non-vitamin K antagonists cause of major or minor bleeding, 12,6% cause of re-embolism despite theurapeutic doses and the rest of them has switched cause of untargeted INR levels. Final distribution of oral anti-coagulant preferences are demonstrated in (Table-1).
NOACs are more effective than the standard treatment in some areas and often associated with lower bleeding complications. Because of admission in standard doses and the lack of a need for routine coagulation monitoring they are companionable than the conventional anticoagulants such as warfarin. NOAC under-use still seems to be one of the major challenges in the real-life treatment of CTEPH. Our study confirms that morbidity and mortality reason may explain the NOAC under-use in CTEPH.