Apixaban versus warfarin in evaluation of progression of atherosclerotic and calcified plaques (prospective randomized trial).

Warfarin has been showed to increase vascular calcification. Apixaban, a direct factor Xa inhibitor, has no interaction with vitamin K and its effect on coronary plaques is unknown. We randomized and compared warfarin and apixaban on progression of coronary atherosclerotic plaques measured by coronary computed tomographic angiography in 66 subjects with non-valvular atrial fibrillation over the period of one-year follow up. There was significant higher total, calcified and low attenuation plaque volume in the group randomized to warfarin as compared to apixaban (all P < .05). Greater volume of total (β = 28.54; P = .03), low attenuation plaque (β = 3.58; P = .02) and calcified (β = 14.10; P = .005) plaque progression was observed in the VKA_group.