Warfarin Treatment Is Associated to Increased Internal Carotid Artery Calcification.

Autor:	Nuotio K; Neurology, Neurocenter, Helsinki University Hospital, Helsinki, Finland.; Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland., Koskinen SM; Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland.; Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland., Mäkitie L; Neurology, Neurocenter, Helsinki University Hospital, Helsinki, Finland.; Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland., Tuimala J; Independent Researcher, Helsinki, Finland., Ijäs P; Neurology, Neurocenter, Helsinki University Hospital, Helsinki, Finland.; Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland., Heikkilä HM; Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland., Saksi J; Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland., Vikatmaa P; Abdominal Center, Vascular Surgery, Helsinki University Hospital, Helsinki, Finland., Sorto P; Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland., Kasari S; Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland., Paakkari I; Pharmacology, Faculty of Medicine, University of Helsinki, Helsinki, Finland., Silvennoinen H; Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland., Valanne L; Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland., Mäyränpää MI; Pathology, Helsinki University and Helsinki University Hospital, Helsinki, Finland., Soinne L; Neurology, Neurocenter, Helsinki University Hospital, Helsinki, Finland.; Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland., Kovanen PT; Wihuri Research Institute, Biomedicum Helsinki 1, Helsinki, Finland., Lindsberg PJ; Neurology, Neurocenter, Helsinki University Hospital, Helsinki, Finland.; Clinical Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland.
Jazyk:	angličtina
Zdroj:	Frontiers in neurology [Front Neurol] 2021 Jul 12; Vol. 12, pp. 696244. Date of Electronic Publication: 2021 Jul 12 (Print Publication: 2021).
DOI:	10.3389/fneur.2021.696244
Abstrakt:	Background: Long-term treatment with the vitamin K antagonist warfarin is widely used for the prevention of venous thrombosis and thromboembolism. However, vitamin K antagonists may promote arterial calcification, a phenomenon that has been previously studied in coronary and peripheral arteries, but not in extracranial carotid arteries. In this observational cohort study, we investigated whether warfarin treatment is associated with calcification of atherosclerotic carotid arteries. Methods: Overall, 500 consecutive patients underwent carotid endarterectomy, 82 of whom had received long-term warfarin therapy. The extent of calcification was assessed with preoperative computed tomography angiography, and both macroscopic morphological grading and microscopic histological examination of each excised carotid plaque were performed after carotid endarterectomy. Results: Compared with non-users, warfarin users had significantly more computed tomography angiography-detectable vascular calcification in the common carotid arteries (odds ratio 2.64, 95% confidence interval 1.51-4.63, P < 0.001) and even more calcification in the internal carotid arteries near the bifurcation (odds ratio 18.27, 95% confidence interval 2.53-2323, P < 0.001). Histological analysis revealed that the intramural calcified area in plaques from warfarin users was significantly larger than in plaques from non-users (95% confidence interval 3.36-13.56, P = 0.0018). Conclusions: Long-lasting warfarin anticoagulation associated with increased calcification of carotid atherosclerotic plaques, particularly in locations known to be the predilection sites of stroke-causing plaques. The clinical significance of this novel finding warrants further investigations. Competing Interests: JT received a lecture fee from Boehringer-Ingelheim in 2014. MM has received lecture fees from Boehringer-Ingelheim, Bristol-Myers Squibb, MSD, and Takeda, as well as congress sponsorship and educational travel support from Pfizer, Roche, Bristol-Myers Squibb, and MSD. PK has received consultancy or lecture fees from Amgen, Novartis, Raisio Group, and Sanofi. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2021 Nuotio, Koskinen, Mäkitie, Tuimala, Ijäs, Heikkilä, Saksi, Vikatmaa, Sorto, Kasari, Paakkari, Silvennoinen, Valanne, Mäyränpää, Soinne, Kovanen and Lindsberg.)
Databáze:	MEDLINE
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