Extent of arterial calcification by conventional vitamin K antagonist treatment

Abstract

Background and aims Vitamin K antagonists (VKA) remain the most frequently prescribed oral anticoagulants worldwide despite the introduction of non-vitamin K antagonist oral anticoagulants (NOAC). VKA interfere with the regeneration of Vitamin K1 and K2, essential to the activation of coagulation factors and activation of matrix-Gla protein, a strong inhibitor of arterial calcifications. This study aimed to clarify whether VKA treatment was associated with the extent of coronary artery calcification (CAC) in a population with no prior cardiovascular disease (CVD). Methods We collected data on cardiovascular risk factors and CAC scores from cardiac CT scans performed as part of clinical examinations (n = 9,672) or research studies (n = 14,166) in the period 2007–2017. Data on use of anticoagulation were obtained from the Danish National Health Service Prescription Database. The association between duration of anticoagulation and categorized CAC score (0, 1–99, 100–399, ≥400) was investigated by ordered logistic regression adjusting for covariates. Results The final study population consisted of 17,254 participants with no prior CVD, of whom 1,748 and 1,144 had been treated with VKA or NOAC, respectively. A longer duration of VKA treatment was associated with higher CAC categories. For each year of VKA treatment, the odds of being in a higher CAC category increased (odds ratio (OR) = 1.032, 95%CI 1.009–1.057). In contrast, NOAC treatment duration was not associated with CAC category (OR = 1.002, 95%CI 0.935–1.074). There was no significant interaction between VKA treatment duration and age on CAC category. Conclusions Adjusted for cardiovascular risk factors, VKA treatment–contrary to NOAC—was associated to higher CAC category.

Bioprosthetic valves and atrial fibrillation: Direct anticoagulants or warfarin

“…Vitamin K2 inhibition results in vascular calcification. 6 There is some concern that chronic use of VKAs can result in native valvular calcification. 7 If a similar phenomenon is seen in the prosthetic valves, it can be detrimental for their durability.…”

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

“…One of the largest studies was a retrospective cohort of 1748 warfarin users and 1148 DOAC users who had CT scans from 2007–2017. For each year of warfarin treatment, the odds of being in a higher coronary artery calcium (CAC) category increased (OR = 1.032, 95% CI 1.009–1.057), while DOAC treatment duration was not associated with CAC category (OR = 1.002, 95% CI 0.935–1.074) [ 62 ].…”

Gut Microbiome, Functional Food, Atherosclerosis, and Vascular Calcifications—Is There a Missing Link?

“…Vitamin K antagonists (VKA), among the most recommended oral anticoagulants, influence the regeneration of vitamin K1 and K2, needed for the activation of coagulation factors and matrix Gla protein, which in turn is responsible for the inhibition of arterial calcification. The study conducted by Hasific et al, evaluating the relationship between VKA treatment and the extent of coronary artery calcifications, showed that a longer period of treatment with VKA, but not novel oral anticoagulants, was associated with the risk of a higher category of coronary artery calcification in patients without previous CVDs [ 124 ].…”