Therapeutic management of idiopathic pulmonary fibrosis (IPF) remains challenging. IPF patients frequently exhibit a hypercoagulable state, and anticoagulant therapy has emerged as a potential strategy; however, its clinical utility remains controversial. To systematically evaluate the efficacy and safety of anticoagulant therapy in IPF patients. Systematic review and meta-analysis of randomised controlled trials. Comprehensive searches were conducted in PubMed, Cochrane Library, EMBASE, Web of Science, CNKI, Wanfang Data, VIP, and CBM databases for randomised controlled trials (RCTs) investigating anticoagulant therapy in IPF, from database inception to February 2025. Two investigators independently screened the literature, extracted data, and assessed risk of bias. Meta-analysis was performed using RevMan 5.3. Seven RCTs involving 504 patients with IPF were included. Compared with control groups not receiving anticoagulants, anticoagulant therapy significantly improved PaO2 (MD = 11.64, 95% CI 7.09-16.18, p < 0.00001), SaO2(MD = 4.44, 95% CI 2.42-6.47, p < 0.0001), and HGF levels (MD = 108.74, 95% CI 88.58 to 128.90, p < 0.00001) but significantly reduced the mMRC score (MD = -0.38, 95% CI -0.62 to -0.14, p = 0.002) and D-dimer levels (MD = -0.08, 95% CI -0.11 to -0.05, p < 0.00001). No significant difference was observed in PaCO2 levels (MD = -4.26, 95% CI -9.09 to 0.56, p = 0.08). Anticoagulant therapy did not demonstrate benefit in reducing all-cause mortality (RR = 3.46, 95% CI 1.57-7.61, p = 0.002) or adverse reactions (MD = 1.44, 95% CI 1.15-1.81, p = 0.002). Anticoagulant therapy may offer clinical benefits in IPF management. However, its lack of mortality benefit and safety concerns warrant cautious interpretation. Clinicians should carefully assess individual bleeding risks before initiating treatment. Due to the limited number of included studies and data constraints, further large-scale, high-quality, multicenter, and long-term RCTs are needed. Future research should prioritise risk stratification, optimised anticoagulation protocols and identification of biomarkers predictive of bleeding risk to inform clinical decision-making. The study protocol was registered with PROSPERO (Registration number: CRD42022349940). Study combining results from multiple clinical trials to evaluate blood-thinning drugs for idiopathic pulmonary fibrosis (IPF) patientsStudy combining results from multiple clinical trials to evaluate blood-thinning drugs for idiopathic pulmonary fibrosis (IPF) patients Why was the study done? Idiopathic pulmonary fibrosis (IPF) is a serious lung disease with limited treatment options. Some studies suggest that blood-thinning drugs (anticoagulants) might help IPF patients because their blood tends to clot more easily. However, whether these drugs truly benefit patients or cause more harm remains highly debated. This study aimed to clarify the benefits and risks of anticoagulants for IPF. What did the researchers do? Researchers gathered and analysed data from all available high-quality clinical trials (published up to February 2025) comparing anticoagulants with no anticoagulants (or placebo) in IPF patients. They combined results from 7 trials involving 504 patients to assess effects on breathing (oxygen levels, shortness of breath), blood markers, survival, and side effects. What did the researchers find? Potential benefits: Anticoagulants improved blood oxygen levels (PaO2 and SaO2), reduced shortness of breath (mMRC score), and lowered blood clotting markers (D-dimer) and a disease-related factor (HGF). No clear change: Blood carbon dioxide levels (PaCO2) were unaffected. Important risks: Anticoagulant therapy did not demonstrate benefit in reducing all-cause mortality or adverse reactions. What do the findings mean? While anticoagulants may improve some symptoms in IPF patients, these potential benefits are outweighed by significantly higher risks of death and adverse effects. Anticoagulants are not recommended as routine treatment for IPF. If considered for individual patients, doctors must carefully weigh bleeding risks. More large, long-term studies are needed to confirm these findings. Future research should focus on: Identifying which patients might benefit safely, Developing safer anticoagulant strategies, Finding biomarkers to predict bleeding risk.
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arXiv · 2024-09-05
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