Warfarin and Vascular Calcification

Poterucha, Timothy J.; Goldhaber, Samuel Z.

doi:10.1016/j.amjmed.2015.11.032

Cited by 87 publications

(66 citation statements)

References 23 publications

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“…17,18 Another objection to the treatment with VKA in patients with CKD is the association of VKA with vascular calcification including calciphylaxis (subcutaneous arteriolar calcification). [19][20][21] Some studies also showed an increased risk for strokes and bleeding in patients with severe renal impairment and VKA therapy related to AF. A retrospective analysis in dialysis patients with AF showed that treatment with warfarin was associated with an increased rate of strokes.…”

Section: Anticoagulation With Vitamin K Antagonists Heparins or Hepmentioning

confidence: 99%

Direct oral anticoagulants in patients with chronic kidney disease: patient selection and special considerations

Lutz

Jurk²,

Schinzel³

2017

IJNRD

103

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Many patients with chronic kidney disease (CKD) receive anticoagulation or antiplatelet therapy due to atrial fibrillation, coronary artery disease, thromboembolic disease, or peripheral artery disease. The treatment usually includes vitamin K antagonists (VKAs) and/or platelet aggregation inhibitors. The direct oral anticoagulants (DOAC) inhibiting factor Xa or thrombin represent an alternative for VKAs. In patients with acute and chronic kidney disease, caution is warranted, as DOACs can accumulate as they are partly eliminated by the kidneys. Thus, they can potentially increase the bleeding risk in patients with CKD. In patients with an estimated glomerular filtration rate (eGFR) above 60 mL/min, DOACs can be used safely with greater efficacy and safety as compared to VKAs. In patients with CKD 3, DOACs are as effective as VKAs with a lower bleeding rate. The more the renal function declines, the lower is the advantage of DOACs over VKAs. Thus, use of DOACs should be avoided in patients with an eGFR below 30 mL/min, particularly, the compounds with a high renal elimination. Available data suggest that DOACs can also be used safely in older patients. In this review, use of DOACs in comparison with VKAs, heparins, and heparinoids, together with special considerations in patients with impaired renal function will be discussed.

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Section: Anticoagulation With Vitamin K Antagonists Heparins or Hepmentioning

confidence: 99%

Direct oral anticoagulants in patients with chronic kidney disease: patient selection and special considerations

Lutz

Jurk²,

Schinzel³

2017

IJNRD

103

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“…Protein S offers neuronal protection during ischaemic/hypoxic injury [4]. Additionally, the use of VKAs may result in arterial calcification [27, 28] due to the inhibition of another VKDP, matrix γ-carboxyglutamate Gla protein (MGP), which prevents systemic calcification by scavenging calcium phosphate in tissues [27]. Finally, vitamin K regulates the metabolism of sphingolipids, the concentration of which correlates positively with serum vitamin K concentrations in the brain [29].…”

Section: Discussionmentioning

confidence: 99%

Use of Vitamin K Antagonists and Brain Morphological Changes in Older Adults: An Exposed/Unexposed Voxel-Based Morphometric Study

Brangier¹,

Celle²,

Roche³

et al. 2018

Dement Geriatr Cogn Disord

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Background: Vitamin K antagonists (VKAs) are commonly used for their role in haemostasis by interfering with the vitamin K cycle. Since vitamin K also participates in brain physiology, this voxel-based morphometric study aimed to determine whether the duration of exposure to VKAs correlated with focal brain volume reduction in older adults. Methods: In this exposed/unexposed (1: 2) study nested within the GAIT (Gait and Alzheimer Interactions Tracking) cohort, 18 participants exposed to VKA (mean age 75 ± 5 years; 33.3% female; mean exposure 2,122 ± 1,799 days) and 36 matched participants using no VKA (mean age 75 ± 5 years; 33.3% female) underwent MRI scanning of the brain. Cortical grey and white matter volumes were automatically segmented using statistical parametric mapping. Age, gender, educational level, history of atrial fibrillation, type of MRI, and total intracranial volume were included as covariables. Results: The duration of exposure to VKA correlated inversely across the whole brain with the subvolumes of two clusters in the grey matter (right frontal inferior operculum and right precuneus) and one cluster in the white matter (left middle frontal gyrus). In contrast, the grade of white matter hyperintensities did not differ according to the use of VKA. Conclusion: We found focal atrophies in older adults exposed to VKA. These findings provide new insights elucidating the effects of VKAs on brain health and function in older adults.

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“…[15]. It has been suggested that long term use of Vitamin K antagonists promote arterial calcification and increases IMT by reducing the function of Vitamin K to prevent calcification [13,14]. In a longitudinal study by Lip GY et al, Warfarin elevated fibrinogen levels 0.36 g/L [16].…”

Section: Chronic Stress and Elevated Fibrinogenmentioning

confidence: 99%

“…This report includes a small sampling of a few common remedies often prescribed by natural health practitioners. Most of these herbs appear to reduce high plasma fibrinogen levels using different physiological pathways than the vitamin K dependent means of Warfarin (Coumadin) [13].…”

Section: Interventionmentioning

confidence: 99%

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Natural Remedies Lower Elevated Fibrinogen Levels in the Prevention of Atherosclerosis

Narayan¹

2017

J Tradi Med Clin Natur

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Warfarin and Vascular Calcification

Cited by 87 publications

References 23 publications

Direct oral anticoagulants in patients with chronic kidney disease: patient selection and special considerations

Direct oral anticoagulants in patients with chronic kidney disease: patient selection and special considerations

Use of Vitamin K Antagonists and Brain Morphological Changes in Older Adults: An Exposed/Unexposed Voxel-Based Morphometric Study

Natural Remedies Lower Elevated Fibrinogen Levels in the Prevention of Atherosclerosis

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