Anticoagulant Efficacy Of Rivaroxaban Versus Warfarin In Patients After Pulmonary Endarterectomy

Background:Chronic thromboembolic pulmonary hypertension(CTEPH)is an infrequent but fatal complication of acute pulmonary embolism necessitating lifelong anticoagulation,regardless of the additional pulmonary endarterectomy(PEA).However,few data exist on the safety and efficacy of vitamin K antagonists(VKAs)and direct oral anticoagulants(DOACs)in CTEPH population.Methods:We retrospectively reviewed the clinical,postoperative anticoagulant therapy and follow-up results of CTEPH patients underwent PEA,and compared rivaroxaban with warfarin of the safety and efficacy in anticoagulant therapy.The principal safety outcome was major or clinically relevant nonmajor bleeding.The primary efficacy outcome was symptomatic recurrent vein thromboembolism(VTE,including pulmonary embolism and deep veins thrombosis).Results:From January 2015 to December 2018,115 CTEPH patients underwent PEA surgery at Fuwai Hospital.There was 1 perioperative death.The mean follow up time was 38.1±14.4 months(2.84 person-years)without patient got lost.Postoperatively,50 patients got rivaroxaban for anticoagulant therapy(Rivaroxaban group),while the other 64 patients got warfarin(Warfarin group).The incidence rates for bleeding events,major bleeding events,and clinically relevant non-major bleeding events in Rivaroxaban group were 36.0%,6.0%,30.0%,respectively;in Warfarin group 35.9%,3.1%,32.8%,respectively.The results of the subgroup analysis showed that warfarin was more common than rivaroxaban in bleeding events for patients with combined pulmonary vasodilators(71.4%vs 20%,p=0.05),The VTE recurrence was higher with Rivaroxaban group(14.0%)than Warfarin group(4.7%),but the difference was not statistically significant(p=0.16).Conclusions:Rivaroxaban was noninferior to warfarin in safety and efficacy for the postoperatively anticoagulant therapy of CTEPH.For CTEPH patients concomitant pulmonary vasodilators postoperatively,rivaroxaban had a lower risk of anticoagulant bleeding than warfarin.However,these conclusions need to be further verified by large-scale randomized controlled trials.