THE EFFECT OF ANTICOAGULANT-THERAPY IN PRIMARY AND ANORECTIC DRUG-INDUCED PULMONARY-HYPERTENSION

In a retrospective study, we tested the hypothesis that anticoagulant therapy with warfarin sodium (Coumadin) has a beneficial influence on the long-term prognosis in patients with primary pulmonary hypertensio n (PPH) and aminorex-induced plexogenic pulmonary hypertension, The st udy included a total of 173 patients from two European cities, One hun dred four of these patients took the anorectic drug aminorex (Menocil) , which was available in some European countries almost 30 years ago; 69 patients had pulmonary hypertension of unexplained etiology, ie, PP H, Fifty-six of the 104 aminorex-treated patients and 24 patients in t he PPH group received warfarin after diagnosis was established, For an alysis, patients were divided into four groups according to their hist ory of aminorex intake and anticoagulant therapy, Survival time, chang es in hemodynamics (pulmonary arterial pressure), and improvement in q uality of life (scored by the New York Heart Association [NYHA] classi fication) were compared and analyzed, We found that aminorex-treated p atients had a better long-term prognosis than those with PPH (7.5 vs 3 .9 years; p less than or equal to 0.001). The best mean survival time of 8.3 years was found in anticoagulated aminorex-treated patients, co mpared to 6.1 years in nonanticoagulated aminorex-treated patients, Mo reover, aminorex-treated patients who received anticoagulant therapy s oon after the onset of symptoms showed significantly better prognosis (10.9 years) than those who commenced treatment 2 years thereafter (5. 9 years) (p less than or equal to 0.05). In patients with PPH, systoli c pulmonary pressure Was shown to influence survival time significantl y (p<0.0005); however, this correlation was not found in aminorex-trea ted patients. An improvement of symptoms like dyspnea on exertion was seen in 44.8% of the anticoagulated aminorex-treated patients, while d eterioration was evident in 72.2% of the nonanticoagulated aminorex-tr eated patients, In conclusion, our study has shown that anticoagulant therapy had a positive influence on long-term survival and a significa nt improvement in quality of life in patients with PPH, in particular in patients with a history of anorectic drug intake.