Can anticoagulants improve the survival rate for patients with idiopathic pulmonary arterial hypertension? A systematic review and meta-analysis.

BACKGROUND: Anticoagulant therapy is believed to be an important component of treatment for idiopathic pulmonary arterial hypertension (IPAH). Recent data suggest that therapy that does not include anticoagulants results in no significant difference in patient survival. We sought to evaluate the effect of anticoagulants on survival in patients with IPAH. METHODS: A systematic review and a random-effects meta-analysis to estimate hazard ratio (HR) and 95% confidence intervals (CI) were performed. PubMed/MEDLINE, Web of Knowledge and other databases were searched for eligible literature. Review articles and references were also screened. RESULTS: 8 studies with a total of 1812 patients with IPAH were included in this analysis. No randomized controlled trials (RCT) were identified. All the 8 studies had a mean complete follow-up ranging from 3 to 14 years. In this analysis, use of anticoagulants did not significantly decrease mortality risk (P = 0.07, HR = 0.77, 95% CI [0.58, 1.02]). Sensitivity analysis showed similar results (P = 0.12, HR = 0.80, 95% CI [0.60, 1.06]). Subgroup analysis showed that anticoagulants performed no significant advantages with the use of PAH-specific therapies (P = 0.82, HR = 0.95, 95% CI [0.63, 1.44]). CONCLUSIONS: No randomized evidence to support the use of anticoagulants in IPAH. No significant benefit for patients' survival was found in our analysis. The potential biases of included observational studies made it hard to achieve a meaningful conclusion. The necessity of anticoagulants for IPAH patients remains to be evaluated.