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

Authors

Kalaimani Elango, Department of Cardiology, University of Nevada Las Vegas School of Medicine, 1701 W Charleston Boulevard Ste. 250, Las Vegas, NV 89102, USA.
Awad Javaid, Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, 1701 W Charleston Boulevard Ste. 250, Las Vegas, NV 89102, USA.
Banveet K. Khetarpal, Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, 1701 W Charleston Boulevard Ste. 250, Las Vegas, NV 89102, USA.
Sathishkumar Ramalingam, Division of Hospital Medicine, Lovelace Medical Center, 601 Dr. Martin Luther King Jr. Avenue NE, Albuquerque, NM 87102, USA.
Krishna Prasad Kolandaivel, Division of Oncology, St. Joseph Medical Center, 523 N 3rd Street, Brainerd, MN 56401, USA.
Kulothungan Gunasekaran, Division of Pulmonary Diseases and Critical Care, Yale New Haven Health Bridgeport Hospital, 267 Grant Street, Bridgeport, CT 06610, USA.
Chowdhury Ahsan, Department of Cardiology, University of Nevada Las Vegas School of Medicine, 1701 W Charleston Boulevard Ste. 250, Las Vegas, NV 89102, USA.

Document Type

Article

Publication Title

Cells

Abstract

Warfarin has been utilized for decades as an effective anticoagulant in patients with a history of strong risk factors for venous thromboembolism (VTE). Established adverse effects include bleeding, skin necrosis, teratogenicity during pregnancy, cholesterol embolization, and nephropathy. One of the lesser-known long-term side effects of warfarin is an increase in systemic arterial calcification. This is significant due to the association between vascular calcification and cardiovascular morbidity and mortality. Direct oral anticoagulants (DOACs) have gained prominence in recent years, as they require less frequent monitoring and have a superior side effect profile to warfarin, specifically in relation to major bleeding. The cost and lack of data for DOACs in some disease processes have precluded universal use. Within the last four years, retrospective cohort studies, observational studies, and randomized trials have shown, through different imaging modalities, that multiple DOACs are associated with slower progression of vascular calcification than warfarin. This review highlights the pathophysiology and mechanisms behind vascular calcification due to warfarin and compares the effect of warfarin and DOACs on systemic vasculature.

DOI

10.3390/cells10040773

Publication Date

3-31-2021

Recommended Citation

Elango, Kalaimani; Javaid, Awad; Khetarpal, Banveet K.; Ramalingam, Sathishkumar; Kolandaivel, Krishna Prasad; Gunasekaran, Kulothungan; and Ahsan, Chowdhury, "The Effects of Warfarin and Direct Oral Anticoagulants on Systemic Vascular Calcification: A Review" (2021). Randomized Controlled Trial. 14.
https://scholar.bridgeporthospital.org/randomized_trial/14

Identifier

33807457 (pubmed); PMC8066517 (pmc); 10.3390/cells10040773 (doi); cells10040773 (pii)