title: Increased Peripheral Arterial Calcification in Patients Receiving Warfarin.
abstract: BACKGROUND
  Matrix Gla protein is a vitamin K-dependent inhibitor of vascular calcification. Warfarin use is associated with increased breast arterial calcification, but whether this is reflective of other arteries or occurs in men is unclear. In this study, the prevalence of calcification in peripheral arteries was compared in patients with and without warfarin therapy.
  
  
  RESULTS
  This retrospective matched cohort study assessed 430 patients with radiographs performed during or after warfarin therapy who were identified by a computerized search of medical records. Each patient was matched to a patient without warfarin exposure based on age, sex, and diabetes status. Patients with warfarin exposure <1 month, history of end-stage renal disease, or serum creatinine >2.0 mg/dl were excluded. Radiographs were reviewed visually for arterial calcification. The prevalence of arterial calcification was 44% greater in patients with versus without warfarin use (30.2% versus 20.9%, P=0.0023) but not on radiographs performed before warfarin therapy (26.4% versus 22.4%, n=156) or prior to 5 years of warfarin therapy. The increase was noted only in the ankle and foot, was limited to a medial pattern of calcification, and was similar in men and women.
  
  
  CONCLUSIONS
  Warfarin use is associated with lower extremity arterial calcification in both men and women independent of age, sex, diabetes status, and other patient characteristics. This may have implications for the choice of therapies for long-term anticoagulation.
authors.affiliation: Renal Division, Emory University School of Medicine, Atlanta, GA (K.H.H., C.N.) Department of Internal Medicine, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea (K.H.H.).
authors.forename: Kum Hyun
authors.initials: KH
authors.lastname: Han
authors.affiliation: Renal Division, Emory University School of Medicine, Atlanta, GA (K.H.H., C.N.).
authors.forename: W Charles
authors.initials: WC
authors.lastname: O'Neill
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects*; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000453:epidemiology; D015995:Prevalence; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D061205:Vascular Calcification / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000453:epidemiology; D014859:Warfarin / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: anticoagulants; peripheral vascular disease
references.citation: J Am Coll Cardiol. 2008 Apr 1;51(13):1292-8
references.pmid: 18371562
references.citation: Blood. 2010 Jun 17;115(24):5121-3
references.pmid: 20354170
references.citation: J Biol Chem. 2011 Aug 19;286(33):28715-28722
references.pmid: 21705322
references.citation: Eur Heart J. 2011 Oct;32(20):2555-62
references.pmid: 21775389
references.citation: Acta Pathol Microbiol Immunol Scand A. 1985 Jan;93(1):13-6
references.pmid: 3969827
references.citation: Thromb Haemost. 2009 Apr;101(4):706-13
references.pmid: 19350115
references.citation: Arterioscler Thromb Vasc Biol. 2015 Jan;35(1):237-42
references.pmid: 25324574
references.citation: Eur Respir J. 2001 Mar;17(3):566-9
references.pmid: 11405537
references.citation: Arterioscler Thromb Vasc Biol. 2015 Feb;35(2):439-47
references.pmid: 25477344
references.citation: Kidney Int. 2014 Mar;85(3):668-76
references.pmid: 24048381
references.citation: Arterioscler Thromb Vasc Biol. 1998 Sep;18(9):1400-7
references.pmid: 9743228
references.citation: Calcif Tissue Int. 2009 Dec;85(6):494-500
references.pmid: 19847375
references.citation: Am J Epidemiol. 1998 Feb 15;147(4):333-41
references.pmid: 9508100
references.citation: N Engl J Med. 2007 Jul 19;357(3):217-27
references.pmid: 17634457
references.citation: Nephrol Dial Transplant. 2012 Apr;27(4):1580-4
references.pmid: 22121234
references.citation: J Am Coll Cardiol. 2008 May 20;51(20):1967-74
references.pmid: 18482666
references.citation: Nature. 1997 Mar 6;386(6620):78-81
references.pmid: 9052783
references.citation: Semin Nephrol. 2013 Mar;33(2):93-105
references.pmid: 23465497
references.citation: JRSM Cardiovasc Dis. 2012 Jul 31;1(4):
references.pmid: 24175067
references.citation: Nat Genet. 1999 Jan;21(1):142-4
references.pmid: 9916809
references.citation: Am J Cardiol. 2005 Sep 15;96(6):747-9
references.pmid: 16169351
references.citation: J Am Coll Cardiol. 2007 May 8;49(18):1860-70
references.pmid: 17481445
references.citation: Arterioscler Thromb Vasc Biol. 1996 Aug;16(8):978-83
references.pmid: 8696962