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Editorial - February 2022

ESC Working Group on Pulmonary Circulation & Right Ventricular Function

Dear Members,

In the past pulmonary arterial hypertension (PAH) was mostly diagnosed in young females without significant cardiovascular comorbidities. However, nowadays PAH patients are older with age related cardiovascular comorbidities including hypertension, diabetes, coronary artery disease, and obesity. The presence of significant comorbidities in PAH patients is challenging because it is associated with poor outcomes and complicate disease management. Moreover, currently there is no consensus on how to define PAH patients with comorbidities and how to optimize their management. Recently published analysis of the GRIPHON trial (Rosenkranz S, European Journal of Heart Failure 2022) assessed the effect of selexipag in PAH patients with cardiovascular comorbidities. Of note in the GRIPHON study approx. half of the patients had at least one cardiovascular comorbidity. Importantly, this post post-hoc analysis showed a reduced risk of experiencing a morbidity/mortality event vs. placebo in PAH patients treated with selexipag irrespective of comorbidity status. These results will help to optimize PAH targeted therapy in patients with cardiovascular comorbidities.

In this edition of the newsletter, we highlight a recent paper entitled “Long-Term Risk for Major Bleeding During Extended Oral Anticoagulant Therapy for First Unprovoked Venous Thromboembolism: A Systematic Review and Meta-analysis”, Ann Intern Med 2021. Precise assessment of the long-term risk for major bleeding in patients anticoagulated beyond the initial 3 to 6 months is one of key determinants in decision making on withholding or continuing anticoagulant therapy after a first unprovoked venous thromboembolism. Analysis of 27 randomized or cohort studies showed that the incidence of major bleeding per 100 person-years was 1.74 events (95% CI, 1.34 to 2.20 events) with VKAs and 1.12 events (CI, 0.72 to 1.62 events) with DOACs. This information will help inform patient prognosis and guide decision making about treatment duration for unprovoked VTE.

On behalf of the Working Group nucleus,

Piotr Pruszczyk Chairperson 2020-2022 and Stefano Barco, Communication Coordinator 2020-2022


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