Tailoring oral anticoagulant treatment in the era of multi-drug therapies for PAH and CTEPH.

IF 6.9 2区 医学 Q1 HEMATOLOGY Blood Reviews Pub Date : 2024-09-04 DOI:10.1016/j.blre.2024.101240
Jean Escal, Geraldine Poenou, Xavier Delavenne, Souad Bezzeghoud, Valentine Mismetti, Marc Humbert, David Montani, Laurent Bertoletti
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Abstract

The use of oral anticoagulants in the management of pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) presents distinct therapeutic challenges and benefits. In PAH, the benefits of oral anticoagulation are uncertain, with studies yielding mixed results on their efficacy and safety. Conversely, oral anticoagulants are a cornerstone in the treatment of CTEPH, where their use is consistently recommended to prevent recurrent thromboembolic events. The choice between vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs) remains a significant clinical question, as each type presents advantages and potential drawbacks. Furthermore, drug-drug interactions (DDIs) with concomitant PAH and CTEPH treatments complicate anticoagulant management, necessitating careful consideration of individual patient regimens. This review examines the current evidence on oral anticoagulant use in PAH and CTEPH and discusses the implications of DDIs within a context of multi-drug treatments, including targeted drugs in PAH.

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在 PAH 和 CTEPH 采用多种药物疗法的时代,调整口服抗凝剂的治疗方法。
在治疗肺动脉高压(PAH)和慢性血栓栓塞性肺动脉高压(CTEPH)过程中使用口服抗凝剂既能带来不同的治疗挑战,也能带来不同的益处。在 PAH 中,口服抗凝药的益处尚不确定,有关其疗效和安全性的研究结果不一。相反,口服抗凝剂是治疗 CTEPH 的基石,在 CTEPH 的治疗中,一直建议使用口服抗凝剂来预防复发性血栓栓塞事件。在维生素 K 拮抗剂 (VKAs) 和直接口服抗凝剂 (DOAC) 之间做出选择仍然是一个重要的临床问题,因为每种药物都有其优点和潜在缺点。此外,同时接受 PAH 和 CTEPH 治疗时的药物间相互作用(DDIs)也使抗凝治疗变得更加复杂,因此有必要仔细考虑患者的个体治疗方案。本综述研究了 PAH 和 CTEPH 使用口服抗凝剂的现有证据,并讨论了多种药物治疗(包括 PAH 靶向药物)背景下 DDIs 的影响。
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来源期刊
Blood Reviews
Blood Reviews 医学-血液学
CiteScore
13.80
自引率
1.40%
发文量
78
期刊介绍: Blood Reviews, a highly regarded international journal, serves as a vital information hub, offering comprehensive evaluations of clinical practices and research insights from esteemed experts. Specially commissioned, peer-reviewed articles authored by leading researchers and practitioners ensure extensive global coverage across all sub-specialties of hematology.
期刊最新文献
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