Anticoagulation of Systemic Sclerosis Patients In Question PDF Print E-mail
Saturday, 18 May 2013 23:43
Australia is in a state of ‘clinical equipoise’ over whether to anticoagulate systemic sclerosis patients with pulmonary hypertension, experts say. And with observational studies showing the treatment is associated with a  fivefold reduction in mortality, the issue demanded a prompt resolution, the team of rheumatologists wrote in this week’s Internal Medicine Journal.

Describing the issue as one of the “most contentious” in the management of patients with connective tissue disease, the doctors said anticoagulation was currently not regarded as standard care in these patients.

A previous study conducted by the authors had revealed that warfarin was used in around 30% of patients, with no Australian centres routinely anticoagulating patients. Practice also varied internationally, they said.

Acknowledging that systemic sclerosis patients had specific bleeding risks that made INR monitoring challenging, the authors said the recent advent of orally administered Xa inhibitors could overcome some of these issues.

“The preliminary evidence favouring a survival benefit with anticoagulation administered in conjunction with PAH-specific therapy makes a compelling case for evaluating its therapeutic efficacy in SSc-PAH,” the study authors wrote.

The authors called for a randomised controlled trial, arguing that a placebo arm was ethically justifiable because of uncertainty around the benefits and relative risks. “The substantially shortened life expectancy of patients with SSc-PAH further adds an element of urgency to the need to resolve this contentious issue,” they added.

Source: Rheumatology Update (2013), "Anticoagulant conundrum for PAH sclerosis"; original article can be viewed here.

 

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