Wu Tian, Huang Jun, Wang Xia, Lian Huilin, Guo Ren, Shi Can
The Third Xiangya Hospital, Central South University, Changsha 410013, China.
Department of Pharmacology, Xiangya School of Pharmaceutical Sciences, Central South University, Changsha 410078, China.
ACS Pharmacol Transl Sci. 2024 Apr 9;7(5):1262-1269. doi: 10.1021/acsptsci.3c00307. eCollection 2024 May 10.
Many patients with atrial fibrillation (AF) requiring long-term use of oral anticoagulants (OACs) are at high risk for vascular calcification and anticoagulation therapy with warfarin exacerbate vascular calcification. However, the effect of nonvitamin K agonists on vascular calcification has not been clearly investigated. This study explored the effects of dabigatran etexilate, rivaroxaban, and warfarin on vascular calcification among 1527 patients with AF. Demographics, comorbidities, laboratory test data, medications, and the prevalence and severity of vascular calcification in different vascular beds were compared. After propensity score matching, the incidence of vascular calcification in the rivaroxaban and warfarin group was significantly higher than that in the nonanticoagulant group, while there was no difference between the dabigatran etexilate group and the nonanticoagulant group. Similarly, we found that the rivaroxaban group had more severe calcification in the overall vascular level ( < 0.001), thoracic aorta ( < 0.001), aortic arch ( = 0.001), and left common carotid artery ( = 0.005) than the nonanticoagulant group. In addition, in the left common carotid artery, there was more severe calcification in the rivaroxaban group than that in the dabigatran group ( = 0.005). Our results suggest that rivaroxaban can significantly increase both the incidence and severity of vascular calcification among patients with AF, while dabigatran etexilate has no such effect. Many patients with AF requiring long-term use of OACs are at high risk for vascular calcification. This is the first study to conduct a head-to-head comparison of the effects of dabigatran etexilate and rivaroxaban on vascular calcification. Rivaroxaban, rather than dabigatran etexilate, promotes vascular calcification in patients with AF, providing important implications to aid clinicians in their choice for OAC selection, especially those at high risk for vascular calcification.
许多需要长期使用口服抗凝剂（OACs）的心房颤动（AF）患者存在血管钙化的高风险，而华法林抗凝治疗会加重血管钙化。然而，非维生素K拮抗剂对血管钙化的影响尚未得到明确研究。本研究探讨了达比加群酯、利伐沙班和华法林对1527例AF患者血管钙化的影响。比较了人口统计学、合并症、实验室检查数据、用药情况以及不同血管床中血管钙化的发生率和严重程度。经过倾向评分匹配后，利伐沙班组和华法林组血管钙化的发生率显著高于非抗凝组，而达比加群酯组与非抗凝组之间无差异。同样，我们发现利伐沙班组在总体血管水平（<0.001）、胸主动脉（<0.001）、主动脉弓（=0.001）和左颈总动脉（=0.005）的钙化程度比非抗凝组更严重。此外，在左颈总动脉中，利伐沙班组的钙化比达比加群组更严重（=0.005）。我们的结果表明，利伐沙班可显著增加AF患者血管钙化的发生率和严重程度，而达比加群酯则无此作用。许多需要长期使用OACs的AF患者存在血管钙化的高风险。这是第一项对达比加群酯和利伐沙班对血管钙化的影响进行直接比较的研究。在AF患者中，促进血管钙化的是利伐沙班而非达比加群酯，这为临床医生选择OAC，尤其是血管钙化高风险患者的OAC选择提供了重要参考。
