Intake of Vitamin K Antagonists and Worsening of Cardiac and Vascular Disease: Results From the Population‐Based Gutenberg Health Study

Eggebrecht, Lisa; Prochaska, Jürgen H.; Schulz, Andreas; Arnold, Natalie; Jünger, Claus; Göbel, Sebastian; Laubert‐Reh, Dagmar; Binder, Harald; Beutel, Manfred E.; Pfeiffer, Nobert; Blankenberg, Stefan; Lackner, Karl J.; Spronk, Henri M. H.; Cate, Hugo Ten; Münzel, Thomas; Wild, Philipp S.

doi:10.1161/jaha.118.008650

Cited by 13 publications

(8 citation statements)

References 33 publications

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“…20 Several studies have also showed that different OACs have variable effect sizes on vascular protection. [33][34][35][36] Further investigation is needed whether different OACs have different risk of silent or subclinical stroke (eg, on the brain imaging), and these findings would be associated with subjects' cognitive function.…”

Section: Discussionmentioning

confidence: 99%

Comparing Warfarin and 4 Direct Oral Anticoagulants for the Risk of Dementia in Patients With Atrial Fibrillation

Lee

Choi

Park

et al. 2021

Stroke

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Background and Purpose: Atrial fibrillation is a risk factor for dementia, and oral anticoagulant use is associated with a decreased risk of dementia in patients with atrial fibrillation. We aimed to investigate whether the risk of dementia would be different between patients treated with direct oral anticoagulants (DOACs) compared with those with warfarin. Methods: Using the Korean nationwide claims database from January 2014 to December 2017, we identified oral anticoagulant–naive nonvalvular atrial fibrillation patients aged ≥40 years. For the comparisons, warfarin and DOAC groups were balanced using the inverse probability of treatment weighting method. The primary outcome was incident dementia. Results: Among 72 846 of total study patients, 25 948 were treated with warfarin, and 46 898 were treated with DOAC (17 193 with rivaroxaban, 9882 with dabigatran, 11 992 with apixaban, and 7831 with edoxaban). During mean 1.3±1.1 years of follow-up, crude incidence of dementia was 4.87 per 100 person-years (1.20 per 100 person-years for vascular dementia and 3.30 per 100 person-years for Alzheimer dementia). Compared with warfarin, DOAC showed a comparable risks of dementia, vascular dementia, and Alzheimer dementia. In subgroup analyses, DOAC was associated with a lower risk of dementia than warfarin, particularly in patients aged 65 to 74 years (hazard ratio, 0.815 [95% CI, 0.709–0.936]) and in patients with prior stroke (hazard ratio, 0.891 [95% CI, 0.820–0.968]). When comparing individual DOACs with warfarin, edoxaban was associated with a lower risk of dementia (hazard ratio, 0.830 [95% CI, 0.740–0.931]). Conclusions: In this large Asian population with atrial fibrillation, DOAC showed a comparable risk of dementia with warfarin overall. DOACs appeared more beneficial than warfarin, in those aged 65 to 74 years or with a history of stroke. For specific DOACs, only edoxaban was associated with a lower risk of dementia than warfarin.

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Section: Discussionmentioning

confidence: 99%

Comparing Warfarin and 4 Direct Oral Anticoagulants for the Risk of Dementia in Patients With Atrial Fibrillation

Lee

Choi

Park

et al. 2021

Stroke

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“…This study also shows an association and dose-response effect of VKAs intake with low grade systemic inflammation. This was shown by the high levels of high-sensitivity C-reactive protein (hsCRP) found in long-term VKAs users when compared with short-term VKAs intake users [67]. A post hoc analysis used serial coronary intravascular ultrasound examinations and involved eight prospective randomized trials.…”

Section: Vitamin K Antagonists (Vkas)mentioning

confidence: 99%

Vitamin K as a Diet Supplement with Impact in Human Health: Current Evidence in Age-Related Diseases

et al. 2020

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Vitamin K health benefits have been recently widely shown to extend beyond blood homeostasis and implicated in chronic low-grade inflammatory diseases such as cardiovascular disease, osteoarthritis, dementia, cognitive impairment, mobility disability, and frailty. Novel and more efficient nutritional and therapeutic options are urgently needed to lower the burden and the associated health care costs of these age-related diseases. Naturally occurring vitamin K comprise the phylloquinone (vitamin K1), and a series of menaquinones broadly designated as vitamin K2 that differ in source, absorption rates, tissue distribution, bioavailability, and target activity. Although vitamin K1 and K2 sources are mainly dietary, consumer preference for diet supplements is growing, especially when derived from marine resources. The aim of this review is to update the reader regarding the specific contribution and effect of each K1 and K2 vitamers in human health, identify potential methods for its sustainable and cost-efficient production, and novel natural sources of vitamin K and formulations to improve absorption and bioavailability. This new information will contribute to foster the use of vitamin K as a health-promoting supplement, which meets the increasing consumer demand. Simultaneously, relevant information on the clinical context and direct health consequences of vitamin K deficiency focusing in aging and age-related diseases will be discussed.

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“…This might result from warfarin accumulation in these patients as CYP2C9 is downregulated in patients with ERSD ( 7 , 9 ). And warfarin needs close monitoring of prothrombin time ( 10 ), deteriorates vascular calcification ( 11 ), and sometimes induces anticoagulant-related nephropathy ( 12 ).…”

Section: Introductionmentioning

confidence: 99%

Use of non-vitamin K antagonists oral anticoagulants in atrial fibrillation patients on dialysis

Zhou

Chen

et al. 2022

Front. Cardiovasc. Med.

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BackgroundNon-vitamin K antagonist oral anticoagulants (NOACs) showed a benefit-risk profile superior to that of warfarin in atrial fibrillation (AF) patients with mild to moderate chronic kidney disease. However, the effectiveness and safety of NOACs in AF patients with end-stage renal disease (ESRD) on dialysis remain unclear. Therefore, we performed a meta-analysis regarding the effect of NOACs vs. warfarin in AF patients undergoing dialysis.MethodsA search of the Pubmed and EMBASE databases until November 2021 was performed. Adjusted risk ratios (RRs) and 95%confidence intervals (CIs) were pooled by a random-effects model with an inverse variance method.ResultsSix studies involving 3,744 NOAC- and 26,973 warfarin- users were deemed to meet the criteria. In the pooled analysis, the use of mixed NOACs had similar incidences of effectiveness and safety outcomes compared with warfarin use. And factor Xa inhibitors (rivaroxaban or apixaban) did not have significantly better effectiveness than warfarin. For the safety outcomes, the use of factor Xa inhibitors was associated with a reduced risk of gastrointestinal bleeding (RR = 0.81, 95% CI 0.70–0.95), but not major bleeding and intracranial bleeding.ConclusionCompared with warfarin, the use of NOACs, especially factor Xa inhibitors (rivaroxaban or apixaban), showed at least similar effectiveness and safety outcomes in AF patients on dialysis.

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Intake of Vitamin K Antagonists and Worsening of Cardiac and Vascular Disease: Results From the Population‐Based Gutenberg Health Study

Cited by 13 publications

References 33 publications

Comparing Warfarin and 4 Direct Oral Anticoagulants for the Risk of Dementia in Patients With Atrial Fibrillation

Comparing Warfarin and 4 Direct Oral Anticoagulants for the Risk of Dementia in Patients With Atrial Fibrillation

Vitamin K as a Diet Supplement with Impact in Human Health: Current Evidence in Age-Related Diseases

Use of non-vitamin K antagonists oral anticoagulants in atrial fibrillation patients on dialysis

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