Different type and dosage of heparin were not associated with the progression of coronary artery calcification in haemodialysis patients

Abstract

Aim Several studies have verified that unfractionated heparin (UFH) and low molecular heparin (LWMH) can induce bone loss, and bone mineral density has been inversely associated with vascular calcification in some clinical researches. But few have focused on the relationship between types and dosages of heparin and the progression of vascular calcification. We observed the progression of coronary artery calcification (CAC) in maintenance haemodialysis (MHD) patients who were treated with UFH and LMWH. Methods This was a prospective prevalent cohort study of MHD patients. Computed tomography was performed at enrolment and 2 years after enrolment, and CAC score was obtained. Demographic and clinical data, baseline and time‐average laboratory indices were collected. Multiple linear regression and logistic regression were used to estimate the influencing factors of progression of CAC. Results In this study, (i) we initially enrolled 69 HD patients, and then 56 patients finished the follow‐up. (ii) Among the total 56 patients, 27 patients (48.2%) were treated with UFH, 14 (25.0%) with LMWH and 15 (26.8%) with both. The median baseline CAC scores of three groups (UFH, LMWH and both users) were 91.0 (1.0, 1052.0), 134.0 (0, 1292.0) and 250.5 (27.0, 1139.0), respectively, with no significant difference (P = 0.663); the median CAC progression scores were 42.0 (0, 364.0), 172.0 (7.0, 653.0) and 118.5 (0, 434.0), respectively, with no significant difference (P = 0.660). (iii) Pearson and spearman correlation analysis shown that the progression of CAC was not associated with cumulative dosage of heparin used. (iv) After adjusted for diabetes mellitus, time‐averaged intact parathyroid hormone, phosphate and alkaline phosphatase, logistic regression analysis showed using different types of heparin was not an independent risk factor for CAC progression; and multiple linear regression analysis showed that the type of heparin used was not associated with CAC progression. Conclusion There were no significant differences in the effects of the types and dosages of heparin on CAC progression in patients on haemodialysis.

Heparins are potent inhibitors of ectonucleotide pyrophosphatase/phospho-diesterase-1 (NPP1) – a promising target for the immunotherapy of cancer

“…Since PPi is a key inhibitor of mineralization ( 58 ), NPP1 inhibitors might eventually lead to abnormal bone development and soft tissue including blood vessel calcification ( 59 ). In fact, chronic application of heparins has been associated with decreased bone stability and soft tissue calcification ( 60 ), although conflicting results have been obtained ( 61 ). The observed effects might be – at least in part – associated with the potent NPP1-inhibition of heparins.…”