Document Detail


Anticoagulant therapy for idiopathic pulmonary fibrosis.
MedLine Citation:
PMID:  16162746     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY OBJECTIVE: To evaluate the effect of anticoagulant therapy on the survival of patients with idiopathic pulmonary fibrosis (IPF). DESIGN: Prospective study. SETTING: Five hospitals located in the Miyagi prefecture in Japan, including a university hospital, a Red Cross hospital, two public general hospitals, and a municipal hospital. PATIENTS: Fifty-six patients with IPF (mean age, 69.4 years; range, 47 to 89) admitted to the hospitals from April 2001 to April 2004. INTERVENTIONS: Patients were assigned to receive prednisolone alone or prednisolone plus anticoagulant therapy. The anticoagulants included oral warfarin in an outpatient setting and low-molecular-weight heparin for rehospitalized patients with severely progressive respiratory failure. MEASUREMENTS AND RESULTS: There was no difference in baseline characteristics, including age, gender, clinical condition, pulmonary function, and plasma d-dimer level between the non-anticoagulant group and the anticoagulant group. The overall survival and hospitalization-free periods were assessed. There was a significant difference between survival curves of the non-anticoagulant group and the anticoagulant group, with a 2.9 hazard ratio (p = 0.04, Cox regression model). There was no significant difference in the probability of a hospitalization-free period between groups. The major cause of clinical deterioration was acute exacerbation during follow-up in the present study. Therefore, the mortality and plasma d-dimer levels in patients with an acute exacerbation were also assessed. The mortality associated with acute exacerbations of IPF in the anticoagulant group was significantly reduced compared to that in the non-anticoagulant group (18% vs 71%, respectively; p = 0.008, Fisher Exact Test). Furthermore, the plasma d-dimer levels in patients who died were significantly higher than those in survivors during acute exacerbation of IPF (3.3 +/- 2.3 microg/mL vs 0.9 +/- 0.7 microg/mL, p < 0.0001). Histologic analysis performed in three patients who died due to an exacerbation of IPF in the non-anticoagulant group demonstrated the features of usual interstitial pneumonia and acute lung injury. CONCLUSIONS: Our data suggested that plasma d-dimer levels are associated with mortality in patients with an acute exacerbation of IPF, and that anticoagulant therapy has a beneficial effect on survival in patients with IPF.
Authors:
Hiroshi Kubo; Katsutoshi Nakayama; Masaru Yanai; Tomoko Suzuki; Mutsuo Yamaya; Mika Watanabe; Hidetada Sasaki
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Publication Detail:
Type:  Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial    
Journal Detail:
Title:  Chest     Volume:  128     ISSN:  0012-3692     ISO Abbreviation:  Chest     Publication Date:  2005 Sep 
Date Detail:
Created Date:  2005-09-15     Completed Date:  2005-11-08     Revised Date:  2006-08-10    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1475-82     Citation Subset:  AIM; IM    
Affiliation:
Department of Geriatric and Respiratory Medicine, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Anti-Inflammatory Agents / therapeutic use
Anticoagulants / therapeutic use*
Biological Markers / blood
Blood Coagulation Disorders / blood,  complications,  drug therapy*
Female
Fibrin Fibrinogen Degradation Products / analysis
Heparin, Low-Molecular-Weight / therapeutic use
Hospitalization
Humans
Male
Middle Aged
Prednisolone / therapeutic use
Prospective Studies
Pulmonary Fibrosis / blood,  complications,  drug therapy*
Survival Analysis
Treatment Outcome
Warfarin / therapeutic use
Chemical
Reg. No./Substance:
0/Anti-Inflammatory Agents; 0/Anticoagulants; 0/Biological Markers; 0/Fibrin Fibrinogen Degradation Products; 0/Heparin, Low-Molecular-Weight; 0/fibrin fragment D; 50-24-8/Prednisolone; 81-81-2/Warfarin
Comments/Corrections
Comment In:
Chest. 2006 Jul;130(1):302-3   [PMID:  16840421 ]

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