Warfarin Treatment Is Associated to Increased Internal Carotid Artery Calcification

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Nuotio , K , Koskinen , S M , Mäkitie , L , Tuimala , J , Ijäs , P , Heikkilä , H M , Saksi , J , Vikatmaa , P , Sorto , P , Kasari , S , Paakkari , I , Silvennoinen , H , Valanne , L , Mäyränpää , M I , Soinne , L , Kovanen , P T & Lindsberg , P J 2021 , ' Warfarin Treatment Is Associated to Increased Internal Carotid Artery Calcification ' , Frontiers in neurology , vol. 12 , 696244 . https://doi.org/10.3389/fneur.2021.696244

Title: Warfarin Treatment Is Associated to Increased Internal Carotid Artery Calcification
Author: Nuotio, Krista; Koskinen, Suvi M.; Mäkitie, Laura; Tuimala, Jarno; Ijäs, Petra; Heikkilä, Hanna M.; Saksi, Jani; Vikatmaa, Pirkka; Sorto, Pia; Kasari, Sonja; Paakkari, Ilari; Silvennoinen, Heli; Valanne, Leena; Mäyränpää, Mikko I.; Soinne, Lauri; Kovanen, Petri T.; Lindsberg, Perttu J.
Contributor: University of Helsinki, HUS Neurocenter
University of Helsinki, HUS Neurocenter
University of Helsinki, HUS Neurocenter
University of Helsinki, Department of Pathology
University of Helsinki, HUS Neurocenter
University of Helsinki, Department of Neurosciences
University of Helsinki, HUS Neurocenter
University of Helsinki, HUS Abdominal Center
University of Helsinki, Department of Neurosciences
University of Helsinki, Department of Neurosciences
University of Helsinki, Medicum
University of Helsinki, HUS Medical Imaging Center
University of Helsinki, HUS Medical Imaging Center
University of Helsinki, HUSLAB
University of Helsinki, Department of Neurosciences
University of Helsinki, Wihuri Research Institute
University of Helsinki, HUS Neurocenter
Date: 2021-07-12
Language: eng
Number of pages: 9
Belongs to series: Frontiers in neurology
ISSN: 1664-2295
URI: http://hdl.handle.net/10138/334374
Abstract: 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.
Subject: carotid artery
warfarin
computed tomography angiography
histology
vascular calcification
calcification
VITAMIN-K ANTAGONIST
VASCULAR CALCIFICATION
CORONARY
ATHEROSCLEROSIS
RISK
MICROCALCIFICATIONS
MECHANISMS
GUIDELINES
MANAGEMENT
PATHOLOGY
3112 Neurosciences
3124 Neurology and psychiatry
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