Effectiveness of oral anticoagulants in precapillary pulmonary hypertension associated with systemic sclerosis: a EUSTAR cohort study

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ID: 329039
2026
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Abstract
Abstract Objectives The role of anticoagulation in systemic sclerosis (SSc) with precapillary pulmonary hypertension (PH) remains controversial, with conflicting evidence regarding its impact on survival, including potential harmful effects. Aiming to address this research gap, we evaluated both mortality and PH worsening in a large SSc-precapillary PH cohort, additionally accounting for SSc-specific risk factors in our analyses, to better inform individualized treatment decisions. Methods This retrospective cohort study included SSc patients from the European Scleroderma Trials and Research database with precapillary PH confirmed by right heart catheterization. The association of OAC use with survival and PH worsening was assessed using Kaplan-Meier estimates and multivariable Cox regression models. To minimize confounding, propensity score matching was additionally performed. Results Among 614 patients included, 143 (23%) received OAC at the time of RHC. At baseline, patients on OAC had worse hemodynamic parameters. No significant association was found between OAC use and survival (HR 0.983 95%CI 0.724—1.334) or PH worsening (HR 1.070 95%CI 0.811—1.412). These findings remained consistent after propensity score matching and in the subgroup of 230 SSc patients with precapillary PH without interstitial lung disease. Conclusions In this large SSc cohort with precapillary PH, we did not observe any clinical benefit associated with OAC, neither in terms of survival nor of PH worsening. Further prospective studies are needed to determine whether specific patient subgroups may benefit from anticoagulation therapy.
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Authors Nicola Farina, Silvia Bellando Randone, Hilde Jenssen-Bjørkekjær, Sébastien Sanges, Patricia Carreira, Paolo Airò, Serena Guiducci, Dilia Giuggioli, Gabriela Riemekasten, Carmen-Pilar Simeón Aznar, Christina Bergmann, Elise Siegert, I. Castellví, Lesley Ann Saketkoo, Jeska de Vries‐Bouwstra, Philipp Klemm, Ulf Müller-Ladner, Alexandra Balbir-Gurman, Vanessa Smith, Florenzo Iannone, Luca Idolazzi, Christopher Denton, Edoardo Rosato, Britta Maurer, Yannick Allanore, Yoshiya Tanaka, Elisabetta Zanatta, Marie‐Elise Truchetet, Masataka Kuwana, M. Martin, Alberto Cauli, Kamal Solanki, Francesco Del Galdo, Ana Maria Gheorghiu, Branimir Anic, Gonçalo Boleto, Gabór Kumánovics, Kristofer Andréasson, Simona Rednic, Lorinda Chung, Susana Oliveira, Marius Cadar, Addolorata Corrado, Carolina de Souza Müller, Vivien Hsu, Yair Levy, Gianluca Moroncini, Jörg Henes, Andra Balanescu, Ellen De Langhe, Carlomaurizio Montecucco, Petros P Sfikakis, Michele Iudici, Stefan Heitmann, Madelon C Vonk, Anna-Maria Hoffmann-Vold, Oliver Distler, Marco Matucci‐Cerinic, Cosimo Bruni
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Journal Lara D. Veeken
Year 2026
DOI
10.1093/rheumatology/keag516
URL
https://doi.org/10.1093/rheumatology/keag516
Keywords Keywords not found

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