Abstract
Background: While procoagulant activity plays a role in IPF pathogenesis, the effect of anticoagulants (AC) as a therapeutic approach in IPF is deleterious. However, the risks associated with oral ACs prescribed in IPF patients with specific medical indications are unknown. We sought to evaluate the prognostic impact of medically indicated AC therapy in IPF.
Methods: The placebo arms of three controlled trials of pirfenidone in IPF (CAPACITY 004 & 006,and ASCEND) were evaluated for AC users and non-users and their indication. Groups were analysed for mortality, hospitalization, FVC decline and adverse events over a 1 year follow up period in a post-hoc analysis.
Results: Of a total of 624 patients, 32 were AC users (mainly Vitamin K antagonists) and 592 were non-users at baseline. Groups were comparable for sex and lung function but differed in the frequency of cardiovascular comorbidities (including atrial fibrillation), venous thromboembolic diseases and pulmonary hypertension. After 52 weeks, all-cause and IPF-related mortality were significantly higher in the AC group (each 15.6%) than in the non-AC group (6.3% and 5.6%, respectively, p=0.0298 and p=0.0138, respectively) while FVC decline ≥10% (p=0.736) and rate of hospitalization (p=0.581) were not affected by AC use. Rates of bleeding and cardiac events did not differ significantly between groups during the trial.
Conclusion: This retrospective analysis suggests a potential harmful effect of anticoagulants used for indications other than treatment of IPF. Future work should analyse this unfavourable relationship further.
- Copyright ©ERS 2015