Association Between DOAC Exposure and Lower-Extremity Arterial Calcification: A Propensity-Matched Exploratory CT...

Area of Science:

• Vascular Medicine
• Radiology
• Pharmacology

Background:

• Lower limb arterial calcification (LLAC) is a key indicator of peripheral artery disease (PAD) severity.
• Vitamin K antagonists may worsen vascular calcification, while direct oral anticoagulants (DOACs) effects on LLAC are less understood.
• Limited data exist on DOACs' impact on lower limb arterial calcification.

Purpose of the Study:

• To investigate the association between DOAC use and LLAC.
• To compare LLAC scores in DOAC users versus non-anticoagulated controls.
• To assess the relationship between LLAC and adverse cardiovascular or perioperative events in DOAC users and controls.

Main Methods:

• Retrospective, single-center, cross-sectional study comparing LLAC on CT scans.
• Propensity score matching (1:1) of 48 DOAC users with 48 controls.
• Quantification of segment-specific LLAC, with a sensitivity analysis for patients on DOACs for ≥5 years.

Main Results:

• No significant difference in total LLAC scores between the overall matched DOAC and control groups.
• Significantly lower proximal LLAC scores (infrarenal aorta, iliac arteries) in a subgroup of patients with ≥5 years of DOAC use.
• Higher LLAC correlated with major adverse cardiovascular events in controls, but not in DOAC-treated patients.

Conclusions:

• Long-term DOAC exposure may be associated with reduced proximal LLAC in a specific subgroup.
• Overall LLAC scores did not differ significantly between DOAC users and controls in the primary analysis.
• Findings are hypothesis-generating due to study limitations (no baseline imaging, potential confounding) and require prospective validation.