The Effects of Warfarin and Direct Oral Anticoagulants on Systemic Vascular Calcification: A Review

Elango, Kalaimani; Javaid, Awad; Khetarpal, Banveet Kaur; Ramalingam, Sathishkumar; Kolandaivel, Krishna Prasad; Gunasekaran, Kulothungan; Ahsan, Chowdhury

doi:10.3390/cells10040773

Cited by 29 publications

(21 citation statements)

References 69 publications

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“… 26 For warfarin, there are also concerns regarding possible risk of calciphylaxis, vascular calcification, vertebral fractures and nephropathy. 13 27 28 Also, the safety and efficacy of warfarin are limited by a narrow therapeutic window which requires stringent INR control between 2.0 and 3.0 and optimally a TTR >70%, which might be difficult to achieve in patients with CKD. 29 …”

Section: Discussionmentioning

confidence: 99%

Oral anticoagulants, time in therapeutic range and renal function over time in real-life patients with atrial fibrillation and chronic kidney disease

Batra

Modica

Renlund³

et al. 2022

Open Heart

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AimsTo describe the use of warfarin and direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF) and chronic kidney disease (CKD), to evaluate changes in renal function over time and predictors of rapid decline, and to describe time in therapeutic range (TTR) and predictors of poor TTR among patients on warfarin.Methods and resultsUsing data from AuriculA, the Swedish oral anticoagulation registry, patients with AF on warfarin or DOAC were identified between 2013 and 2018 (N=6567). Estimated glomerular filtration rate (eGFR) was calculated and categorised into normal (≥90 mL/min/1.73 m2), mild CKD (60–89 mL/min/1.73 m2), moderate CKD (30–59 mL/min/1.73 m2), severe CKD (15–29 mL/min/1.73 m2) and end-stage CKD (<15 mL/min/1.73 m2)/dialysis. TTR was estimated using international normalised ratio (INR) measurements. Predictors of eGFR decline over time and of poor TTR were estimated using regression analysis. Between 2013 and 2018, use of DOAC increased from 9.2% to 89.3%, with a corresponding decline in warfarin. A similar trend was observed in patients with mild to moderate CKD, while DOAC over warfarin increased slower among patients with severe to end-stage CKD/dialysis. In patients treated with warfarin, the median TTR was 77.1%. Worse TTR was observed among patients with severe CKD (70.0%) and end-stage CKD/dialysis (67.5%). A gradual annual decline in eGFR was observed (−1.1 mL/min/1.73 m2), with a more rapid decline among patients with older age, female sex, diabetes mellitus and/or heart failure.ConclusionIn patients with AF, use of DOAC has steadily increased across different CKD stages, but not in patients with severe to end-stage CKD/dialysis despite these patients having poor INR control. Patients with AF have a gradual decline in renal function, with a more rapid decline among a subgroup of patients.

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Section: Discussionmentioning

confidence: 99%

Oral anticoagulants, time in therapeutic range and renal function over time in real-life patients with atrial fibrillation and chronic kidney disease

Batra

Modica

Renlund³

et al. 2022

Open Heart

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“…There was no significant relationship between groups regarding the use of anticoagulation and the presence of BAC and this may be due to the small number of included patients that were kept on oral anticoagulants during or years before our study. VC with the use of oral anticoagulants is usually dependent on dose and duration of administration (16) . Also, we found statistically significant differences between study groups regarding the presence of BAC among study groups subdivided by abnormal lipid profile constituents (low HDL, high LDL, high VLDL, high triglyceride, and high cholesterol).…”

Section: Discussionmentioning

confidence: 99%

Association of Fibroblast Growth Factor-23 and Early Detection of Breast Arterial Calcification in Different Stages of Chronic Kidney Disease Patients

Ibrahim

Tawfik

Ahmed

et al. 2022

Suez Canal University Medical Journal

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Background: Vascular calcification (VC) plays a major role in cardiovascular disease (CVD), which is one of the main causes of mortality in patients with chronic kidney disease (CKD). During the early stages of CKD, Fibroblast growth factor-23 (FGF-23) levels increase to keep serum phosphorus within the normal range. FGF23 may be associated with death and cardiovascular events in CKD patients. Aim: The study aimed at early detection of breast arterial calcification (BAC) and higher levels of FGF-23 as indicators of systemic VC in patients with different stages of CKD. Methodology: The patients were divided into 3 groups; representing stages 2, 3 & 4 of CKD women, and the 4 th group was considered as a control group. The selected participants were subjected to history taking, mammogram to detect BAC and biochemical assessment of lipid profile, Serum creatinine, Mg, P, Ca, PTH and FGF23. Results: the presence of BAC in about 81.8% of stage 4 CKD patients compared with 50% in stage 3 CKD, also in the majority of stage 4 CKD patients had high FGF-23. Receiver operator characteristic (ROC) curve analysis showed serum FGF-23 as a potential predictor of BAC (AUC=0.874) in CKD patients at the cut-off point of 77.5ng/ml (sensitivity 78%, specificity 76%). Conclusion: Although it is difficult to determine the definite stage at which the risk of VC begins but, in our study, it began late in stage 2 CKD, gradually increased prevalence through stage 3, and became significantly higher in stage 4. FGF-23 could be a good predictor of BAC in CKD

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“…Anticoagulant therapy with viatmin K antagonists, which is widely used worldwide, inevitably leads to suboptimal carboxylation of Gla proteins due to their mode of action, which has pronounced negative effects on the cardiovascular system [108][109][110][111] .…”

Section: Discussionmentioning

confidence: 99%

Matrix-GLA-Protein and Vascular Calcification: Can Diet Influence the Consequences of Matrix GLA Protein Inactivation? A Review

Mirzaie

Kusnirova

Addicks³

et al. 2021

ijirms

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In vascular calcification, as a physiological process, intimal arterial calcification (IAC) associated with increased cardiovascular risk is distinguished from medial arterial calcification (MAC) localized mainly in the lamina elatica interna, which are not only based on different pathophysiological mechanisms. They also lead to different cardiovascular diseases. While intimal arterial calcification involves inflammation and lipid accumulation, a calcification process similar to desmal ossification plays the main role in medial arterial calcification. In this context, the phenotype change of smooth muscle cells from muscular type to synthesizing form in the tunica media is considered to be of great importance, which puts the matrix GLA protein, mainly involved in bone metabolism, in the center of interest. The present review work elucidates the molecular biological basis of interaction of matrix GLA protein subunits in the pathogenesis of vascular calcifications and the influence of diet on the consequences of underactivation of matrix GLA protein.

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The Effects of Warfarin and Direct Oral Anticoagulants on Systemic Vascular Calcification: A Review

Cited by 29 publications

References 69 publications

Oral anticoagulants, time in therapeutic range and renal function over time in real-life patients with atrial fibrillation and chronic kidney disease

Oral anticoagulants, time in therapeutic range and renal function over time in real-life patients with atrial fibrillation and chronic kidney disease

Association of Fibroblast Growth Factor-23 and Early Detection of Breast Arterial Calcification in Different Stages of Chronic Kidney Disease Patients

Matrix-GLA-Protein and Vascular Calcification: Can Diet Influence the Consequences of Matrix GLA Protein Inactivation? A Review

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