Direct oral anticoagulants seen as effective as VKAs in CTEPH

DOACs deemed potential alternative to standard treatment

Patricia Inácio, PhD avatar

by Patricia Inácio, PhD |

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A doctor hands a glass of water to a patient who is taking an oral medication.

Direct oral anticoagulants (DOACs) — a type of blood thinner medication — are as safe and effective as vitamin K antagonists (VKAs), the standard blood thinner used to treat chronic thromboembolic pulmonary hypertension (CTEPH), according to a meta-analysis of published studies.

The findings support the use of DOACs as a potential “viable alternative to VKAs in the administration of thromboprophylaxis [prevention of blood clots] for CTEPH patients in actual clinical settings,” researchers wrote.

Their study, “Direct Oral Anticoagulants in Chronic Thromboembolic Pulmonary Hypertension: First Meta-Analysis of Prospective Studies,” was published in Clinical and Applied Thrombosis/Hemostasis.

CTEPH is a rare form of pulmonary hypertension, a condition associated with high blood pressure in the blood vessels of the lungs, that arises from a pulmonary embolism, or blockage in a pulmonary artery.

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DOACs offer convenience, ease

Oral anticoagulants are a cornerstone of CTEPH treatment. They can be vitamin K antagonists, such as warfarin (brand names Coumadin, Jantoven), or DOACs. DOACs are more selective than VKAs, inhibiting the coagulation factor Xa or thrombin, key players in the coagulation signaling cascade.

Recently developed DOACs include dabigatran (sold under the brand name Pradaxa, among others), rivaroxaban (brand name Xarelto, among others), apixaban (brand name Eliquis, among others), and edoxaban (brand name Savaysa).

VKAs have been the standard of care in CTEPH, but they require frequent dose monitoring and adjustments, and may interact with other medications or food.

While “DOACs are likely to offer several advantages over VKAs, including increased convenience and ease of use for both healthcare providers and patients,” their safety and effectiveness in people with CTEPH is still not well established.

To get a better understanding of the performance of DOACs in people with CTEPH, scientists in China systematically reviewed studies published up to February 2024 on the use of VKAs and DOACs in CTEPH patients.

Of 402 studies evaluated for eligibility, four studies — two randomized clinical trials and two prospective studies, covering a total of 2,038 CTEPH patients — were included in the meta-analysis, which reviewed pooled data from multiple published studies.

Patients were followed from six months to four years. A total of 1,287 patients used VKAs, and 751 used DOACs. In two studies, people treated with VKAs had longer disease duration than those treated with DOACs, which suggests DOACs “could be a more popular option in newly diagnosed CTEPH,” the researchers wrote.

After pooling data from all the studies, the researchers found the effectiveness of DOACs was similar to that of VKAs, as shown by similar all-cause mortality rates: 3.33% in each group. No significant differences were seen between groups regarding the recurrence of venous thromboembolism (VTE), which occurs when a blood clot forms in a vein. That was 1.46% in the DOAC group and in 2.12% in the VKAs group.

Safety analysis showed no significant differences between DOACs and VKAs, as shown by similar rates in major bleeding events (2.22% vs. 3.71%) and minor bleeding events (4.17% vs. 13.3%), as well as any bleeding (5.33% vs. 9.94%). These findings were maintained irrespective of the study type.

Overall, “DOACs and VKAs demonstrate similar levels of effectiveness and safety in the treatment of CTEPH,” the researchers wrote, adding that “further prospective clinical studies should be undertaken to confirm our findings.”

A Conversation With Rare Disease Advocates