Choice of specific and anticoagulant therapy in patients with newly diagnosed chronic thromboembolic pulmonary hypertension, depending on operability status

Abstract

Aim. To study the features of anticoagulant and specific therapy in newly diagnosed patients with chronic thromboembolic pulmonary hypertension (CTEPH) depending on operability status.Material and methods. The study included 319 patients with CTEPH, hospitalized for the first time in the E.I. Chazov National Medical Research Center of Cardiology for the period from 2012 to 2021. The diagnosis was established according to current guidelines. Depending on operability status, which was assessed by a multidisciplinary team, two following groups were formed: patients with inoperable CTEPH (n=222) and patients with operable CTEPH who underwent pulmonary thromboendarterectomy (n=97) (time from diagnosis to surgery, 13,3 [6,3; 27,1] months). Demographic, functional status, anticoagulant therapy and specific therapy regimens were analyzed.Results. At the time of initial admission to the expert center, 80,56% of patients received anticoagulant therapy, most often warfarin in both inoperable (38,74%) and operable patients with CTEPH (55,67%), respectively, and rivaroxaban (25,68% and 20,62%, respectively); 6,27% took only antiplatelet agents, and 13,17% did not receive anticoagulant therapy. In the hospital, inoperable patients were most often prescribed low molecular weight heparins in therapeutic doses (47,3%), warfarin — 38,7%, and to a lesser extent (12,16%) — direct oral anticoagulants (DOACs). Operable patients were more often prescribed warfarin (54,64%), while low molecular weight heparins — in 37,1%, and individual patients were prescribed (8,25%) DOACs.Specific therapy at the admission time was received by 19,59% of operable and 23,42% of inoperable patients with CTEPH, mainly in the sildenafil monotherapy regimen. After verification of the diagnosis, the majority of patients (64,4% of inoperable and 46,4% of operable patients with CTEPH) received monotherapy with sildenafil (72,82%) and riociguat (46,75%). The addition of a second drug, mainly within the initial combination therapy, was required in 5,15% of operable patients and 10,81% of inoperable patients, while 1,06% and 0,9% of operable and inoperable patients with CTEPH, respectively, received triple specific therapy.Conclusion. For the first time in Russian practice, anticoagulant and specific therapy were studied in newly diagnosed patients with CTEPH, depending on the operability status.