Warfarin Accelerates Medial Arterial Calcification in Humans
Warfarin Accelerates Medial Arterial Calcification in Humans
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DOI：
10.1161/atvbaha.119.313879
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发表时间：
2020-05-01
影响因子：
8.7
通讯作者：
O'Neill, W. Charles
中科院分区：
文献类型：
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作者：
Alappan, Harish R.;Kaur, Gurleen;O'Neill, W. Charles
目的：华法林与人类内侧动脉钙化有关，但这种影响的大小和特异性以及其他危险因素的作用尚不清楚。使用系列乳房X光检查，比较没有接受抗凝剂、华法林或其他抗凝剂的妇女，以及在使用华法林之前、期间和之后的动脉钙化进展。方法和结果：通过计算机搜索包括肾功能和糖尿病在内的医疗记录，可以识别接受华法林检查的患者。钙化动脉段的长度被测量，进展以每乳房每年毫米表示，并以中位数和四分位数范围(IQR)表示。在肾功能正常的女性中(估计肾小球滤过率和GT；每1.73m(2)每分钟60毫升)，华法林使用者的进展是对照组的3.9倍：9.9(3.8-16)比2.5(0.7-6.7)，P=0.0003，但在使用其他抗凝剂的患者中没有增加。在纵向分析中，11例患者开始使用华法林后，病情进展从2.1IQR0.3~3.9分增加到13.8IQR7.8~38.7分(P=0.011)，停用华法林后从8.8分(IQR1.1~10分)下降到1.9分(IQR6.7%，P=0.024)。在患有慢性肾脏疾病的华法林使用者中，钙化进展相似(7.3IQR3.6-17，n=29)，但在终末期肾病患者中显著加速(47[IQR31-183]，n=11；P=0.0002)。糖尿病患者和非糖尿病患者的病情进展相似(10.1[IQR，3.8-24]比7.8[IQR，3.6-15])，且与年龄(r=0.09)或华法林治疗时间(r=0.12)无关。这种作用在终末期肾病中明显增强。
Objective:Warfarin is associated with medial arterial calcification in humans, but the magnitude and specificity of this effect and the role of other risk factors are unknown. Using serial mammograms, progression of arterial calcification was compared in women receiving no anticoagulants, warfarin, or other anticoagulants, and before, during, and after warfarin use.Approach and Results:Warfarin users with mammograms were identified by computerized searches of medical records that included renal function and diabetes mellitus. Lengths of calcified arterial segments were measured, with progression expressed as millimeters per breast per year and presented as medians and interquartile range (IQR). In women with normal renal function (estimated glomerular filtration rate >60 mL/minute per 1.73 m(2)), progression was 3.9-fold greater in warfarin users: 9.9 (3.8-16) versus 2.5 (0.7-6.7) in controls, P=0.0003, but not increased in users of other anticoagulants. In longitudinal analyses, progression increased from 2.1 (IQR, 0.3-3.9) to 13.8 (IQR, 7.8-38.7; P=0.011) after starting warfarin (n=11) and decreased from 8.8 (IQR, 1.1-10) to 1.9 (IQR, -10 to 6.7; P=0.024) after discontinuation of warfarin (n=13). Progression of calcification was similar in warfarin users with chronic kidney disease (7.3 [IQR, 3.6-17], n=29) but markedly accelerated in warfarin users with end-stage renal disease (47 [IQR, 31-183], n=11; P=0.0002). Progression was similar in diabetic and nondiabetic warfarin users (10.1 [IQR, 3.8-24] versus 7.8 [IQR, 3.6-15]) and did not correlate with age (r=0.09) or duration of warfarin therapy (r=0.12).Conclusions:Warfarin significantly accelerates medial arterial calcification in humans. This effect is markedly augmented in end-stage renal disease.