Korean J Intern Med.  2015 Nov;30(6):837-845. 10.3904/kjim.2015.30.6.837.

Survival benefits of warfarin in Korean patients with idiopathic pulmonary arterial hypertension

• Kang BJ
• Oh YM
• Lee SD
• Lee JS

• KMID: 2381588
• DOI: http://doi.org/10.3904/kjim.2015.30.6.837

Abstract

BACKGROUND/AIMS
Idiopathic pulmonary arterial hypertension (IPAH) is an incurable disease with high mortality. Although most studies recommend anticoagulation treatment for IPAH, the benefits are uncertain, particularly in Korea, where it has not been studied. The purpose of this study was to evaluate survival outcomes of Korean patients with IPAH treated with warfarin.
METHODS
We performed a retrospective cohort study of patients diagnosed previously with pulmonary arterial hypertension (PAH) at the Asan Medical Center in Korea, between January 1994 and February 2013. We excluded patients with associated PAH, patients who did not undergo right heart catheterization (RHC), and patients with a positive vasoreactivity test. Patients in the study cohort were classified into a "warfarin group" and a "non-warfarin group," according to the treatment they received during the first year after diagnosis.
RESULTS
We identified 31 patients with IPAH and a negative vasoreactivity test on RHC. Median patient age was 36.0 years, and 23 patients (74.2%) were female. The median time from the onset of symptoms to diagnosis was 19.0 months, and the most common presenting symptom was dyspnea. Survival rates of the patients at 1, 3, 5, and 10 years were 90.2%, 79.5%, 62.7%, and 34.8%, respectively. The mean survival period was 12.0 years in the warfarin group and 6.1 years in the non-warfarin group. Warfarin treatment had significant survival benefits in patients with IPAH (p = 0.023).
CONCLUSIONS
Warfarin treatment substantially improved survival outcomes in Korean cases of IPAH.

Keyword

Anticoagulants; Korea; Hypertension, pulmonary; Survival; Warfarin

MeSH Terms

Adult
Anticoagulants/*therapeutic use
Asian Continental Ancestry Group
Familial Primary Pulmonary Hypertension/diagnosis/*drug therapy/ethnology/mortality
Female
Humans
Kaplan-Meier Estimate
Male
Proportional Hazards Models
Protective Factors
Republic of Korea
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
Warfarin/*therapeutic use
Anticoagulants
Warfarin