Scleroderma pulmonary hypertension: anticoagulation was not associated with better survival

Design

Retrospective cohort with propensity matching (EUSTAR)

Population

614 patients with SSc and catheter-confirmed precapillary PH

Primary outcome

Mortality and PH worsening

Effect

Survival HR 0.98 (95% CI 0.72 to 1.33); PH worsening HR 1.07 (0.81 to 1.41)

The EUSTAR database identified 614 patients with systemic sclerosis and precapillary pulmonary hypertension confirmed by right heart catheterisation; 143 (23%) were on oral anticoagulation at diagnosis.

Anticoagulation was not associated with survival (HR 0.98, 95% CI 0.72 to 1.33) or with worsening pulmonary hypertension (HR 1.07, 0.81 to 1.41). Results held after propensity matching and in the 230 patients without interstitial lung disease. Anticoagulated patients had worse haemodynamics at baseline.

Earlier data have hinted at harm from anticoagulation in this group, largely from bleeding including gastrointestinal telangiectasia. This cohort shows no benefit to set against that risk. Anticoagulation should be for its own indications — atrial fibrillation, venous thromboembolism — not for the pulmonary hypertension.

• Do not start anticoagulation for SSc-associated pulmonary hypertension alone.
• Review patients already anticoagulated: is there another indication?
• Weigh gastrointestinal bleeding risk from telangiectasia and GAVE.
• Continue PAH-specific therapy through a pulmonary hypertension centre.

Why it matters

It removes a residual reason some clinicians still anticoagulate these patients.

Don't overread it

Observational; it shows no association, not proven absence of any effect in every subgroup.

The statistics, in plain English

A hazard ratio of 0.98 with an interval from 0.72 to 1.33 means no detectable effect either way. Confounding by indication — sicker patients receiving anticoagulation — could hide a small benefit or harm, but propensity matching did not change the result.

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