Anticoagulation increases risk for death, transplant in patients with ILD
The need for anticoagulation in patients with interstitial lung disease is associated with an increased risk for death and transplant, according to findings published in Chest.
“Patients with ILD on anticoagulation have worse outcomes than those not on anticoagulation,” Christopher S. King, MD, pulmonologist at the Advanced Lung Disease and Transplant Clinic at Inova Fairfax Hospital, Virginia, told Healio. “It also appeared that warfarin had worse outcomes associated with it than [direct oral anticoagulants].”
The analysis included 1,911 patients in the Pulmonary Fibrosis Foundation registry. In the cohort, 1,176 patients had idiopathic pulmonary fibrosis, 201 had idiopathic interstitial pneumonia other than IPF, 287 had connective tissue disease-associated ILD, 152 had chronic hypersensitivity pneumonitis and 95 had other ILDs.
Patients were categorized into no anticoagulation (n = 174; mean age, 67.37 years), direct oral anticoagulation (DOAC) use (n = 93; mean age, 70.45 years) or warfarin use (n = 81; mean age, 71.4 years).
Researchers observed a twofold increased risk for death or transplant in patients receiving DOACs (HR = 2.058; 95% CI, 1.037-4.084) and a 2.5-fold increased risk with warfarin (HR = 2.752; 95% CI, 1.471-5.147). DOACs were not associated with an increased risk for mortality after adjusting for confounding variables (HR = 1.51; 95% CI, 0.709-3.215), but patients anticoagulated with warfarin were at an increased risk for mortality (HR = 2.101; 95% CI, 1.025-4.307).
Warfarin was associated with reduced transplant-free survival in patients with IPF (HR = 2.781; 95% CI, 1.336-5.791), but DOACs were not (HR = 1.495; 95% CI, 0.602-3.71) in the unadjusted Cox proportional hazard analysis.
There was no statistically significant difference in survival between patients receiving warfarin and patients receiving a DOAC.
“If there is no compelling indication to use warfarin, I would recommend use of DOACs,” King said.
DOACs in ILD would be ideal but is unlikely to ever occur. It is also unknown why warfarin appears to be worse.
“Careful, ongoing observational data of large registries should continue to be monitored,” King said. “We also plan to see if warfarin and DOACs affect the rate of decline in lung function differently.”