title: Does anticoagulation in Eisenmenger syndrome impact long-term survival?
abstract: OBJECTIVE
  To determine the impact of anticoagulation on survival in Eisenmenger syndrome.
  
  
  BACKGROUND
  The use of anticoagulation for primary prevention of adverse events in patients with Eisenmenger syndrome has been proposed but not studied. Strong arguments have been made both for and against anticoagulation based on the known risk of hemoptysis and pulmonary vascular thrombosis.
  
  
  METHODS
  Retrospective cohort study at a tertiary referral hospital.
  
  
  METHODS
  One hundred forty-four patients with established Eisenmenger physiology all underwent initial laboratory, echocardiographic, and catheterization evaluation after initial referral. We retrospectively identified patients who were started on anticoagulation (AC) and compared them to patients who did not receive anticoagulation therapy (non-AC). Baseline variables were compared between groups, as well as between survivors and nonsurvivors. Analyses of prognostic factors and survival were done using Cox and Kaplan-Meier methods.
  
  
  METHODS
  The primary outcome was death since time of baseline evaluation.
  
  
  RESULTS
  We identified 48 anticoagulated and 44 non-anticoagulated patients with Eisenmenger physiology (oxygen saturation 82 ± 9%, PaO(2) 48 ± 8 mm Hg, hemoglobin 18.6 ± 4 g/dL). More atrial septal defect patients were in the AC group, but there were no other baseline differences in clinical, functional, or hemodynamic data. After mean follow-up of 7 ± 5.4 years (range 1-31), 11 patients died in the AC and 10 died in the non-AC group. There was no survival difference between groups (log rank test = 1.78; P is not significant). For the entire cohort, mortality was significantly associated with New York Heart Association class 3-4 (hazard ratio = 4.2), evidence of right heart failure (hazard ratio = 13.6), and a mean corpuscular volume <80 fL (hazard ratio = 3.8). Use of anticoagulation did not impact survival. Bleeding complications occurred in seven (16%) of AC patients, including two fatalities.
  
  
  CONCLUSIONS
  Anticoagulation had no impact on long-term survival in this limited study. These data may be useful in considering future studies addressing this question.
authors.affiliation: Cardiopulmonary Department, Ignacio Chavez National Institute of Cardiology, Mexico City, Mexico.
authors.forename: Julio
authors.initials: J
authors.lastname: Sandoval
authors.forename: Luis E
authors.initials: LE
authors.lastname: Santos
authors.forename: Julio
authors.initials: J
authors.lastname: Córdova
authors.forename: Tomás
authors.initials: T
authors.lastname: Pulido
authors.forename: Gerardo
authors.initials: G
authors.lastname: Gutiérrez
authors.forename: Edgar
authors.initials: E
authors.lastname: Bautista
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Martinez Guerra
authors.forename: Héctor
authors.initials: H
authors.lastname: Peña
authors.forename: Craig S
authors.initials: CS
authors.lastname: Broberg
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D004541:Eisenmenger Complex / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D006470:Hemorrhage / Q000139:chemically induced / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008800:Mexico; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000925:Anticoagulants