Efficacy and Safety of Anticoagulants in Patients With Idiopathic Pulmonary Fibrosis: A Meta-Analysis.

Background: There is a known association between coagulation abnormalities and idiopathic pulmonary fibrosis (IPF), but it remains unclear whether anticoagulant treatment can extend the lifespan of IPF patients. This systematic review and meta-analysis aim to evaluate the efficacy and safety of anticoagulants in patients with IPF. Methods: A comprehensive search was conducted in PubMed, Embase, Cochrane, and Web of Science from their inception until June 30, 2024, with an English language restriction. We selected clinical studies that met the inclusion criteria after reviewing titles, abstracts, and full texts. Results: Three randomized controlled trials and five prospective studies, including 2185 patients, were analyzed. Compared to standard treatment, anticoagulants did not significantly affect overall mortality in IPF patients. However, excluding studies with warfarin monotherapy, other anticoagulants extended patient survival (OR = 0.56, 95% CI [0.33, 0.95], p = 0.03). Anticoagulants were associated with significantly increased adverse events (OR = 2.48, 95% CI [1.16, 5.32], p = 0.68) but improved lung function (forced vital capacity, FVC), increased lung capacity, and reduced plasma D-dimer levels. No significant differences were observed in the 6-min walk test (6MWT) or diffusing capacity of the lungs for carbon monoxide (DLCO). Conclusion: The study suggests that anticoagulants may extend the lifespan of IPF patients and improve lung function. However, they also increase the risk of adverse events such as bleeding. However, there is an increased risk of adverse events, such as bleeding. This may be due to the distinct mechanisms of action, risk profiles, and clinical outcomes of each drug, although the exact causes remain unclear. Further meta-analyses based on individual patient data are needed to confirm these findings.