Nicola Farina, Silvia Bellando Randone, Hilde Jenssen-Bjørkekjær, Sebastien Sanges, Patricia Carreira, Paolo Airò, Serena Guiducci, Dilia Giuggioli, Gabriela Riemekasten, Carmen-Pilar Simeón Aznar, Christina Bergmann, Elise Siegert, Ivan Castellví, Lesley Ann Saketkoo, Jeska de Vries-Bouwstra, Philipp Klemm, Ulf Müller-Ladner, Alexandra Balbir-Gurman, Vanessa Smith, Florenzo Iannone, Luca Idolazzi, Christopher Denton, Edoardo Rosato, Britta Maurer, Yannick Allanore, Yoshiya Tanaka, Elisabetta Zanatta, Marie-Elise Truchetet, Masataka Kuwana, Mickaël Martin, Alberto Cauli, Kamal Solanki, Francesco Del Galdo, Ana Maria Gheorghiu, Branimir Anic, Gonçalo Boleto, Gábor Kumánovics, Kristofer Andréasson, Simona Rednic, Lorinda S Chung, Susana Oliveira, Marius Cadar, Addolorata Corrado, Carolina de Souza Müller, Vivien M Hsu, Yair Levy, Gianluca Moroncini, Jörg Henes, Andra Balanescu, Ellen De Langhe, Carlomaurizio Montecucco, Petros P Sfikakis, Michele Iudici, Stefan Heitmann, Madelon C Vonk, Anna-Maria Hoffmann-Vold, Oliver Distler, Marco Matucci Cerinic, Cosimo Bruni
In this large SSc cohort with precapillary PH, we did not observe any clinical benefit associated with OAC, neither in terms of survival nor of PH worsening. Further prospective studies are needed to determine whether specific patient subgroups may benefit from anticoagulation therapy.
OBJECTIVES: The role of anticoagulation in systemic sclerosis (SSc) with precapillary pulmonary hypertension (PH) remains controversial, with conflicting evidence regarding its impact on survival, including potential harmful effects. Aiming to address this research gap, we evaluated both mortality and PH worsening in a large SSc-precapillary PH cohort, additionally accounting for SSc-specific risk factors in our analyses, to better inform individualized treatment decisions.
METHODS: This retrospective cohort study included SSc patients from the European Scleroderma Trials and Research database with precapillary PH confirmed by right heart catheterization. The association of OAC use with survival and PH worsening was assessed using Kaplan-Meier estimates and multivariable Cox regression models. To minimize confounding, propensity score matching was additionally performed.
RESULTS: Among 614 patients included, 143 (23%) received OAC at the time of RHC. At baseline, patients on OAC had worse hemodynamic parameters. No significant association was found between OAC use and survival (HR 0.983 95%CI 0.724-1.334) or PH worsening (HR 1.070 95%CI 0.811-1.412). These findings remained consistent after propensity score matching and in the subgroup of 230 SSc patients with precapillary PH without interstitial lung disease.
CONCLUSIONS: In this large SSc cohort with precapillary PH, we did not observe any clinical benefit associated with OAC, neither in terms of survival nor of PH worsening. Further prospective studies are needed to determine whether specific patient subgroups may benefit from anticoagulation therapy.