Vitamin K antagonist use was associated with a significantly increased risk of coronary artery calcification (OR 1.21) compared to patients not treated with VKA.
Meta-Analysis (n=45,757)
Does Vitamin K antagonist use increase vascular and valvular calcification?
Vitamin K antagonist use is significantly associated with increased risks of coronary, extra-coronary, and aortic valve calcification.
Effect estimate: OR 1.21 (95% CI 1.08-1.36)
p-value: p=0.001
Background Many patients treated with Vitamin K antagonists (VKA) for anticoagulation have concomitant vascular or valvular calcification. This meta-analysis aimed to evaluate a hypothesis that vascular and valvular calcification is a side-effect of VKA treatment. Methods We conducted a systematic literature search to identify studies that reported vascular or valvular calcification in patients treated with VKA. The associations between VKA use and calcification were analyzed with random-effects inverse variance models and reported as odds ratios (OR) and 95% confidence intervals (95% CI). In addition, univariate meta-regression analyses were utilized to identify any effect moderators. Results Thirty-five studies were included (45,757 patients; 6,251 VKA users). The median follow-up was 2.3 years interquartile range (IQR) of 1.2–4.0; age 66.2 ± 3.6 years (mean ± SD); the majority of participants were males 77% (IQR: 72–95%). VKA use was associated with an increased OR for coronary artery calcification 1.21 (1.08, 1.36), p = 0.001, moderated by the duration of treatment meta-regression coefficient B of 0.08 (0.03, 0.13), p = 0.0005. Extra-coronary calcification affecting the aorta, carotid artery, breast artery, and arteries of lower extremities, was also increased in VKA treated patients 1.86 (1.43, 2.42), p 0.00001 and moderated by the author-reported statistical adjustments of the effect estimates B: −0.63 (−1.19, −0.08), p = 0.016. The effect of VKA on the aortic valve calcification was significant 3.07 (1.90, 4.96), p 0.00001; however, these studies suffered from a high risk of publication bias. Conclusion Vascular and valvular calcification are potential side effects of VKA. The clinical significance of these side effects on cardiovascular outcomes deserves further investigation.
Kosciuszek et al. (Fri,) conducted a meta-analysis in Cardiovascular calcification (n=45,757). Vitamin K antagonists (VKA) vs. Non-VKA (other anticoagulants or no anticoagulants) was evaluated on Coronary artery calcification (OR 1.21, 95% CI 1.08-1.36, p=0.001). Vitamin K antagonist use was associated with a significantly increased risk of coronary artery calcification (OR 1.21) compared to patients not treated with VKA.