title: Association of warfarin use with valvular and vascular calcification: a review.
abstract: Vitamin K is required for the activity of various biologically active proteins in our body. Apart from clotting factors, vitamin K-dependent proteins include regulatory proteins like protein C, protein S, protein Z, osteocalcin, growth arrest-specific gene 6 protein, and matrix Gla protein. Glutamic acid residues in matrix Gla protein are γ-carboxylated by vitamin K-dependent γ-carboxylase, which enables it to inhibit calcification. Warfarin, being a vitamin K antagonist, inhibits this process, and has been associated with calcification in various animal and human studies. Though no specific guidelines are currently available to prevent or treat this less-recognized side effect, discontinuing warfarin and using an alternative anticoagulant seems to be a reasonable option. Newer anticoagulants such as dabigatran and rivaroxaban offer promise as future therapeutic options in such cases. Drugs including statins, alendronate, osteoprotegerin, and vitamin K are currently under study as therapies to prevent or treat warfarin-associated calcification. Copyright © 2011 Wiley Periodicals, Inc. The authors have no funding, financial relationships, or conflicts of interest to disclose.
authors.affiliation: Department of Medicine, Division of Cardiology, New York Medical College, Valhalla, New York. drpchandrasekar@gmail.com
authors.forename: Chandrasekar
authors.initials: C
authors.lastname: Palaniswamy
authors.forename: Arunabh
authors.initials: A
authors.lastname: Sekhri
authors.forename: Wilbert S
authors.initials: WS
authors.lastname: Aronow
authors.forename: Ankur
authors.initials: A
authors.lastname: Kalra
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Peterson
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D002114:Calcinosis / Q000139:chemically induced / Q000188:drug therapy*; D004164:Diphosphonates / Q000627:therapeutic use; D006349:Heart Valve Diseases / Q000139:chemically induced / Q000188:drug therapy*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006931:Hyperbaric Oxygenation; D009131:Muscle, Smooth, Vascular / Q000166:cytology*; D053244:Osteoprotegerin / Q000627:therapeutic use; D014812:Vitamin K / Q000627:therapeutic use; D014859:Warfarin / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D004164:Diphosphonates; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D053244:Osteoprotegerin; D014812:Vitamin K; D014859:Warfarin