Research progress of warfarin-associated vascular calcification and its possible therapy

Vascular calcification is a common comorbidity in elderly patients with diabetes mellitus or renal insufficiency. A large number of studies have shown that vascular calcification can be induced and accelerated in patients undergoing long-term treatment with warfarin, leading to some severe complications, such as hypertension, atherosclerosis, valvular calcification, and coronary calcification, especially in the population with atrial fibrillation, hemodialysis, and chronic kidney disease. Warfarin inhibits the activation of vitamin K-dependent coagulation factors and affects the function of vitamin K-dependent proteins via interference of the vitamin K cycle by antagonizing vitamin K. One of its consequences is adverse effects on the expression and function of matrix Gla protein, one of the important vitamin K-dependent proteins. Matrix Gla protein acts as an inhibitor of vascular calcification by blocking bone morphogenetic protein signaling or promoting the phagocytosis of apoptotic bodies; moreover, it restrains the formation of calcification directly resulting in the promotion of vascular calcification. This article also discusses the various treatments for vascular calcification caused by warfarin.