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Survival benefits of warfarin in Korean patients with idiopathic pulmonary arterial hypertension.

Kang BJ, Oh YM, Lee SD, Lee JS - Korean J. Intern. Med. (2015)

Bottom Line: We excluded patients with associated PAH, patients who did not undergo right heart catheterization (RHC), and patients with a positive vasoreactivity test.Warfarin treatment had significant survival benefits in patients with IPAH (p = 0.023).Warfarin treatment substantially improved survival outcomes in Korean cases of IPAH.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT

Background/aims: Idiopathic pulmonary arterial hypertension (IPAH) is an incurable disease with high mortality. Although most studies recommend anticoagulation treatment for IPAH, the benefits are uncertain, particularly in Korea, where it has not been studied. The purpose of this study was to evaluate survival outcomes of Korean patients with IPAH treated with warfarin.

Methods: We performed a retrospective cohort study of patients diagnosed previously with pulmonary arterial hypertension (PAH) at the Asan Medical Center in Korea, between January 1994 and February 2013. We excluded patients with associated PAH, patients who did not undergo right heart catheterization (RHC), and patients with a positive vasoreactivity test. Patients in the study cohort were classified into a "warfarin group" and a "non-warfarin group," according to the treatment they received during the first year after diagnosis.

Results: We identified 31 patients with IPAH and a negative vasoreactivity test on RHC. Median patient age was 36.0 years, and 23 patients (74.2%) were female. The median time from the onset of symptoms to diagnosis was 19.0 months, and the most common presenting symptom was dyspnea. Survival rates of the patients at 1, 3, 5, and 10 years were 90.2%, 79.5%, 62.7%, and 34.8%, respectively. The mean survival period was 12.0 years in the warfarin group and 6.1 years in the non-warfarin group. Warfarin treatment had significant survival benefits in patients with IPAH (p = 0.023).

Conclusions: Warfarin treatment substantially improved survival outcomes in Korean cases of IPAH.

No MeSH data available.


Related in: MedlinePlus

Flow chart of the selection scheme used for patient enrollment.
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f1-kjim-30-6-837: Flow chart of the selection scheme used for patient enrollment.

Mentions: A total of 85 patients with PAH were enrolled initially in our study. We isolated the patients with IPAH by excluding 16 patients with associated PAH (connective tissue disease [11], congenital heart disease [4], and portal hypertension [1]). Among the remaining 69 patients with IPAH, we further excluded 12 patients who did not undergo RHC, 20 who were not compatible with the PAH diagnostic criteria, and six with positive vasoreactivity on RHC. Of the final group of 31 patients with IPAH and a negative vasoreactivity test on RHC, 10 received warfarin (warfarin group) and 21 were treated without warfarin (non-warfarin group) within the first year after the diagnosis (Fig. 1).


Survival benefits of warfarin in Korean patients with idiopathic pulmonary arterial hypertension.

Kang BJ, Oh YM, Lee SD, Lee JS - Korean J. Intern. Med. (2015)

Flow chart of the selection scheme used for patient enrollment.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4642013&req=5

f1-kjim-30-6-837: Flow chart of the selection scheme used for patient enrollment.
Mentions: A total of 85 patients with PAH were enrolled initially in our study. We isolated the patients with IPAH by excluding 16 patients with associated PAH (connective tissue disease [11], congenital heart disease [4], and portal hypertension [1]). Among the remaining 69 patients with IPAH, we further excluded 12 patients who did not undergo RHC, 20 who were not compatible with the PAH diagnostic criteria, and six with positive vasoreactivity on RHC. Of the final group of 31 patients with IPAH and a negative vasoreactivity test on RHC, 10 received warfarin (warfarin group) and 21 were treated without warfarin (non-warfarin group) within the first year after the diagnosis (Fig. 1).

Bottom Line: We excluded patients with associated PAH, patients who did not undergo right heart catheterization (RHC), and patients with a positive vasoreactivity test.Warfarin treatment had significant survival benefits in patients with IPAH (p = 0.023).Warfarin treatment substantially improved survival outcomes in Korean cases of IPAH.

View Article: PubMed Central - PubMed

Affiliation: Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT

Background/aims: Idiopathic pulmonary arterial hypertension (IPAH) is an incurable disease with high mortality. Although most studies recommend anticoagulation treatment for IPAH, the benefits are uncertain, particularly in Korea, where it has not been studied. The purpose of this study was to evaluate survival outcomes of Korean patients with IPAH treated with warfarin.

Methods: We performed a retrospective cohort study of patients diagnosed previously with pulmonary arterial hypertension (PAH) at the Asan Medical Center in Korea, between January 1994 and February 2013. We excluded patients with associated PAH, patients who did not undergo right heart catheterization (RHC), and patients with a positive vasoreactivity test. Patients in the study cohort were classified into a "warfarin group" and a "non-warfarin group," according to the treatment they received during the first year after diagnosis.

Results: We identified 31 patients with IPAH and a negative vasoreactivity test on RHC. Median patient age was 36.0 years, and 23 patients (74.2%) were female. The median time from the onset of symptoms to diagnosis was 19.0 months, and the most common presenting symptom was dyspnea. Survival rates of the patients at 1, 3, 5, and 10 years were 90.2%, 79.5%, 62.7%, and 34.8%, respectively. The mean survival period was 12.0 years in the warfarin group and 6.1 years in the non-warfarin group. Warfarin treatment had significant survival benefits in patients with IPAH (p = 0.023).

Conclusions: Warfarin treatment substantially improved survival outcomes in Korean cases of IPAH.

No MeSH data available.


Related in: MedlinePlus