Abstract 18290: Warfarin Use is Associated With Reduced Mortality in Patients with Left Ventricular Systolic Dysfunction and Pulmonary Hypertension
Background: The presence of pulmonary hypertension in patients with left ventricular systolic dysfunction (LVSD) results in an additional increase in mortality. In pulmonary hypertension pathological changes within the lung microcirculation include thrombosis, even in the absence of clinically manifest thromboembolic disease. However, anticoagulation for pulmonary hypertension in those with LVSD is controversial, unless coexistent thromboembolic disease or atrial fibrillation is evident.
Methods: The Tayside echocardiography database was linked to dispensed prescribing, laboratory and hospital admission coding data as well as the national death registry. All patients undergoing echocardiography between 1994 and 2007 with LVSD and an RVSP of greater than 35 mmHg were included. Patients with pulmonary embolism prior to study entry were excluded. Cox regression was used to assess the influence of warfarin prescription on mortality, adjusting for known confounders.
Results: Study criteria were met by 2419 patients (mean age, 73.91 ± 11.5 years; 57% male). Mean RVSP for the cohort was 42.8 ± 12.5 mmHg with 1078 deaths during a mean follow-up of 2.06 years. Warfarin was prescribed to 1,086 (45%) of this cohort. In the multivariate proportional hazards model, the adjusted HR for warfarin use was 0.78, 95% CI [0.67 - 0.90], p = 0.001. A similar result was obtained in the propensity score analysis.
Conclusion: Warfarin use was associated with reduced mortality in those with LVSD and pulmonary hypertension. Adequately designed prospective randomised controlled trials are required to validate this finding given the limitations of this observational study.
- © 2011 by American Heart Association, Inc.