IMR Press / RCM / Volume 23 / Issue 9 / DOI: 10.31083/j.rcm2309322
Open Access Review
Warfarin-Induced Calcification: Potential Prevention and Treatment Strategies
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1 Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, 710032 Xi'an, Shaanxi, China
*Correspondence: (Jincheng Liu)
These authors contributed equally.
Academic Editors: Daniel I. Simon and Teruo Inoue
Rev. Cardiovasc. Med. 2022, 23(9), 322;
Submitted: 21 April 2022 | Revised: 6 June 2022 | Accepted: 6 June 2022 | Published: 16 September 2022
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Warfarin is clinically used as the first choice for long-term anticoagulant therapy, and for the prevention of thromboembolic events. However, when used at low doses in the long term or high doses in the short term, warfarin treatment may result in tissue calcifications—such as calcifications in the coronary arteries, peripheral vascular system, blood vessels of patients with atrial fibrillation and chronic kidney disease, and vascular valves—and atherosclerotic plaque calcification. These warfarin-induced calcifications may affect cardiovascular function and exacerbate diseases such as diabetes and hypertension. Studies have shown that quercetin, osteoprotegerin, sclerosin, and sodium thiosulfate may alleviate these effects by interfering in the Wnt/β-catenin, TG2/β-catenin, Bone Morphogenetic Protein 2 (BMP2), and Eicosapentaenoic Acid/Matrix Metallopeptidase-9 (EPA/MMP-9) pathways, respectively. Nevertheless, the mechanism underlying warfarin-induced calcification remains unknown. Therefore, the question as to how to effectively attenuate the calcification induced by warfarin and ensure its anticoagulant effect remains an urgent clinical problem that needs to be resolved. To utilize warfarin rationally and to effectively attenuate the calcifications, we focused on the clinical phenomena, molecular mechanisms, and potential strategies to prevent calcification. Highlighting these aspects could provide new insights into the effective utilization of warfarin and the reduction of its associated calcification effects.

Fig. 1.
82070264/ National Natural Science Foundation of China
82070503/ National Natural Science Foundation of China
2022ZDLSF01-09/ The Key R&D Program of Shaanxi Province
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