Effect of Warfarin Treatment on Survival of Patients with Pulmonary Arterial Hypertension (PAH) in the Registry to Evaluate Early and Long-Term PAH Disease Management (REVEAL)

Trial (n=187 on warfarin and 187 matched controls) found no significant survival advantage was observed in patients on warfarin. In patients with PAH linked to systemic sclerosis, long-term warfarin was associated with poorer survival than in patients not on warfarin.

An editorial notes that there is now major uncertainty about the role warfarin should play in idiopathic pulmonary arterial hypertension in the modern era. The author makes the following recommendations:

 

1. If there are relative contraindications, warfarin should be avoided.

 

2. If warfarin use diminishes, the luxury of not worrying about whether thrombosis or emboli may be contributing to patient deterioration will be lost.

 

3. There may be subgroups of patients where warfarin may be more likely to be valuable: patients at greater risk of thromboemboli as a result of venous congestion, immobility, risk of thrombus forming on chronically indwelling central lines particularly if patent foramen ovale present, lower cardiac output, or higher pulmonary vascular resistance.