title: Risk of alveolar hemorrhage in patients with primary pulmonary hypertension--anticoagulation and epoprostenol therapy.
abstract: BACKGROUND
  Anticoagulation therapy and continuous intravenous infusion of epoprostenol are the standard treatment for primary pulmonary hypertension (PPH). Because epoprostenol has an antiplatelet effect, concomitant use of an anticoagulant could increase the likelihood of hemorrhagic complications.
  
  
  RESULTS
  In the present study, 31 consecutive patients with PPH (10 men, 21 women, mean +/- SD age, 28.5+/-10.1 years) treated with anticoagulation and epoprostenol between April 1999 and December 2003 were retrospectively evaluated. Clinical and hematological data at the time of the bleeding episode were retrieved from the medical records. Nine patients (22.6%) experienced 11 bleeding episodes: 9 episodes (81.8%) were alveolar hemorrhage and 2 patients were in severe respiratory distress. The mean dose of epoprostenol at the time of the first bleeding episode was 89.0 +/-40.5 ng.kg(-1).min(-1) (range, 28.1-164.0). More of the patients who did not have a bleeding episode remain alive than did patients with bleeding episodes (59% vs 33%) nor did they require lung transplantation.
  
  
  CONCLUSIONS
  A considerable number of patients with PPH who received combined anticoagulant and high-dose epoprostenol therapy developed alveolar hemorrhage, which can be fatal.
authors.affiliation: Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine and Dentistry, Japan. aiko-oky@umin.ac.jp
authors.forename: Aiko
authors.initials: A
authors.lastname: Ogawa
authors.forename: Hiromi
authors.initials: H
authors.lastname: Matsubara
authors.forename: Hideki
authors.initials: H
authors.lastname: Fujio
authors.forename: Katsumasa
authors.initials: K
authors.lastname: Miyaji
authors.forename: Kazufumi
authors.initials: K
authors.lastname: Nakamura
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Morita
authors.forename: Hironori
authors.initials: H
authors.lastname: Saito
authors.forename: Kengo Fukushima
authors.initials: KF
authors.lastname: Kusano
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Emori
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Date
authors.forename: Tohru
authors.initials: T
authors.lastname: Ohe
mesh_terms: D000293:Adolescent; D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use; D011464:Epoprostenol / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced* / Q000401:mortality; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000401:mortality; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D011650:Pulmonary Alveoli / Q000098:blood supply*; D012189:Retrospective Studies; D012306:Risk
chemical_list: D000925:Anticoagulants; D000959:Antihypertensive Agents; D010975:Platelet Aggregation Inhibitors; D011464:Epoprostenol