Vitamin K Antagonist Use and Risk for Intracranial Carotid Artery Calcification in Patients With Intracerebral Hemorrhage

Abstract

Background: Intracranial carotid artery calcification (ICAC) on computed tomography (CT) is a marker of atherosclerosis and an independent predictor of vascular events including stroke. While vitamin K antagonists (VKAs) are used to prevent embolic stroke, they have been shown to increase levels of both coronary and extracoronary artery calcification. This has not been studied for (intracranial) carotid arteries. The aim of this study is to investigate the association between VKA use and degree of ICAC. We tested our hypothesis in a cohort of patients with nontraumatic intracerebral hemorrhage (ICH) of which a substantial part used VKAs. Materials and Methods: We retrospectively semiquantified ICAC on brain unenhanced CT of consecutive adult patients with nontraumatic ICH. Assessment was performed blinded to clinical characteristics and status of VKA use. We used a 5-point visual scale and dichotomized degree of ICAC in low and high degree. Patient demographics, VKA use, duration of VKA treatment, as well as known risk factors for intracranial calcification were collected. Univariable and multivariable logistic regression analyses were performed to investigate the association between ICAC and VKA use. Results: Three hundred and seventy-six nontraumatic ICH patients were included of whom 77 were using VKAs (20.5%) with a median treatment duration of 35 months. Any degree of ICAC was detected in 289 patients (76.9%). Univariable analysis showed that a high degree of ICAC was significantly associated with older age [odds ratio (OR), 1.06, 95% confidence interval (CI), 1.03-1.08], hypertension (OR, 2.14; 95% CI, 1.27-3.62), diabetes mellitus (OR, 2.38; 95% CI, 1.27-4.49), and the use of VKAs (OR, 1.84; 95% CI, 1.06-3.20). In multivariable regression analysis, only older age was significantly associated with a higher degree of ICAC (OR, 1.05; 95% CI, 1.02-1.08), while VKA use was not (OR, 1.22; 95% CI, 0.67-2.24). Conclusions: Our findings do not support VKA use as an independent risk factor for higher ICAC degree in patients with ICH. We could not confirm the concerns about VKA use and intracranial carotid vascular calcification. We suggest further research in other cohorts with VKA users such as patients with ischemic stroke and atrial fibrillation.

Warfarin Treatment Is Associated to Increased Internal Carotid Artery Calcification

“…However, there are only a few studies that have investigated the association of warfarin and vascular calcification in carotid arteries ( 20 , 21 ), and none of them has studied vascular calcification in extracranial carotid arteries. Hence, the present clinical investigation was undertaken to evaluate the hypothesis that chronic warfarin use is associated with vascular calcification in atherosclerotic carotid artery disease.…”

Clinical Significance of miR-21-5p in Predicting Occurrence and Progression of Uremic Vascular Calcification in Patients with End-Stage Renal Disease

“… 22 VC is an independent risk factor for cardiovascular events caused morbidity and mortality, and patients who undergo long-term hemodialysis are more likely to develop coronary calcification. 23 In the present study, a total of 120 ESRD patients were recruited, and among them, 82 cases were diagnosed with VC, reflecting a high incidence of VC in ESRD patients. Therefore, it is particularly important for early diagnosis and timely intervention for ESRD patients at high risk of VC.…”

Vitamin K antagonists and cardiovascular calcification: A systematic review and meta-analysis

“…Nine study cohorts were cross-sectional with an unspecified duration of treatment (28,33,43,44,46,47,53,56,58). The medical history of the patients included coronary artery disease (CAD) (27,32,39), chronic kidney disease CKD (including patients with ESRD) (29, 40-43, 46, 47, 53, 55), calcific aortic valve disease or aortic stenosis (CAVD/AS) (28,56,57,60), atrial fibrillation (AF/NVAF) (28,29,32,34,38,39,49,54,55,58,61), metallic prosthetic valves (36), lower limb amputation (44), carotid atherectomy (48), non-traumatic cerebral hemorrhage (50) or underwent cardiac CT (33, 35) or mammography (40, 52) tests for diagnostic or screening purposes. Two studies included the general population from health registries (30,59).…”