Chest
Clinical Investigations: Pulmonary VasculatureThe Effect of Anticoagulant Therapy in Primary and Anorectic Drug-Induced Pulmonary Hypertension
Section snippets
Patients
One hundred seventy-three patients (29 men, 144 women) with primary or drug-induced pulmonary hypertension from the Vienna and Berne cardiac centers were studied retrospectively with regard to survival time, changes in pulmonary artery pressure, and quality of life as scored by the New York Heart Association (NYHA) classification. Secondary causes, such as pulmonary embolism, obstructive and restrictive lung disease, intracardial and extracardial shunt lesions, and cardiomyopathies were
Survival Time
General Remarks: We observed that patients with exogenous pulmonary hypertension, such as aminorex-induced plexogenic pulmonary arteriopathy, had a significant better survival time than patients with idiopathic or PPH, independent of any anticoagulant therapy (7.5±0.6 years vs 3.9±0.5 years; p≤0.001). For the entire patient population studied, regardless of whether pulmonary hypertension was exogenous or not, anticoagulation generally showed a significant influence in survival time (7.2±0.6
Discussion
Pulmonary hypertension is usually secondary to cardiac or pulmonary disease and only rarely is “primary, idiopathic” or “unexplained.”7 Aminorex fumarate, which became available as an anorectic drug in three European countries (Germany, Switzerland, Austria), caused an increase in the number of cases of unexplained pulmonary arterial hypertension between 1965 and 1969, also called plexogenic pulmonary arteriopathy.8
Treatment of primary or unexplained pulmonary hypertension remains among the
Acknowledgment
The authors thank Valentin Fuster, MD, and Charles Hales, MD, for their helpful review of this manuscript. We also thank Jo Anne Fordham for proofreading the manuscript and Michael Hiegetsberger, PhD, who produced the graphs for this article.
References (34)
The kingdom of the near-dead: the shortened unnatural life history of primary pulmonary hypertension
Chest
(1987)Primary pulmonary hypertension
Prog Cardiovasc Dis
(1988)- et al.
Primary pulmonary hypertension: length of survival in patients referred for heart-lung transplantation
Chest
(1987) - et al.
Characteristics of surviving and nonsurviving patients with primary pulmonary hypertension
Am J Med
(1984) - et al.
Adverse hemodynamic and clinical effects of calcium channel blockade in pulmonary hypertension secondary to obliterative pulmonary vascular disease
J Am Coll Cardiol
(1984) - et al.
Comparative effects of hydralazine, nifedipine and amrinone in primary pulmonary hypertension
Am J Cardiol
(1983) - et al.
Reassessment of the effects of vasodilator drugs in primary pulmonary hypertension: guidelines for determining a pulmonary vasodilator response
Am Heart J
(1983) Aminorex pulmonary hypertension
- et al.
Treatment of primary pulmonary hypertension with intravenous epoprostenol
Br Heart J
(1987) - et al.
High dose calcium channel-blocking therapy for primary pulmonary hypertension: evidence for long term reduction in pulmonary arterial pressure and regression of right ventricular hypertrophy
Circulation
(1987)
Anticoagulation in the treatment of pulmonary hypertension
The effect of high doses of calcium-channel blockers on survival in primary pulmonary hypertension
n Engl J Med
Chronische pulmonale hypertonie vascularen ursprungs, plexogene pulmonale arteriopathie und der appetitzügler aminorex: nachlese zu einer epidemie
Schweiz Med Wochenschr
Primary pulmonary hypertension
BMJ
Drug and dietary induced pulmonary hypertension
Evolution of primary pulmonary hypertension
Prog Respir Res
Primary pulmonary hypertension
Br Heart J
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