Does Anticoagulation in Eisenmenger Syndrome Impact Long-term Survival?

Julio Sandoval, Luis E. Santos, Julio Córdova, Tomás Pulido, Gerardo Gutiérrez, Edgar Bautista, Maria Luisa Martinez Guerra, Héctor Peña, Craig S. Broberg

    Research output: Contribution to journalArticle

    28 Scopus citations

    Abstract

    Objective. To determine the impact of anticoagulation on survival in Eisenmenger syndrome. Background. The use of anticoagulation for primary prevention of adverse events in patients with Eisenmenger syndrome has been proposed but not studied. Strong arguments have been made both for and against anticoagulation based on the known risk of hemoptysis and pulmonary vascular thrombosis. Design and Setting. Retrospective cohort study at a tertiary referral hospital. Patients and Interventions. One hundred forty-four patients with established Eisenmenger physiology all underwent initial laboratory, echocardiographic, and catheterization evaluation after initial referral. We retrospectively identified patients who were started on anticoagulation (AC) and compared them to patients who did not receive anticoagulation therapy (non-AC). Baseline variables were compared between groups, as well as between survivors and nonsurvivors. Analyses of prognostic factors and survival were done using Cox and Kaplan-Meier methods. Outcome Measures. The primary outcome was death since time of baseline evaluation. Results. We identified 48 anticoagulated and 44 nonanticoagulated patients with Eisenmenger physiology (oxygen saturation 82±9%, PaO 2 48±8mmHg, hemoglobin 18.6±4g/dL). More atrial septal defect patients were in the AC group, but there were no other baseline differences in clinical, functional, or hemodynamic data. After mean follow-up of 7±5.4years (range 1-31), 11 patients died in the AC and 10 died in the non-AC group. There was no survival difference between groups (log rank test=1.78; P is not significant). For the entire cohort, mortality was significantly associated with New York Heart Association class 3-4 (hazard ratio=4.2), evidence of right heart failure (hazard ratio=13.6), and a mean corpuscular volume <80fL (hazard ratio=3.8). Use of anticoagulation did not impact survival. Bleeding complications occurred in seven (16%) of AC patients, including two fatalities. Conclusions. Anticoagulation had no impact on long-term survival in this limited study. These data may be useful in considering future studies addressing this question.

    Original languageEnglish (US)
    Pages (from-to)268-276
    Number of pages9
    JournalCongenital Heart Disease
    Volume7
    Issue number3
    DOIs
    StatePublished - May 1 2012

    Keywords

    • Anticoagulation
    • Cyanosis
    • Eisenmenger syndrome
    • Hemoptysis
    • Pulmonary arterial hypertension

    ASJC Scopus subject areas

    • Pediatrics, Perinatology, and Child Health
    • Surgery
    • Radiology Nuclear Medicine and imaging
    • Cardiology and Cardiovascular Medicine

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  • Cite this

    Sandoval, J., Santos, L. E., Córdova, J., Pulido, T., Gutiérrez, G., Bautista, E., Martinez Guerra, M. L., Peña, H., & Broberg, C. S. (2012). Does Anticoagulation in Eisenmenger Syndrome Impact Long-term Survival? Congenital Heart Disease, 7(3), 268-276. https://doi.org/10.1111/j.1747-0803.2012.00633.x