5 research outputs found
The Effects of Warfarin and Direct Oral Anticoagulants on Systemic Vascular Calcification: A Review
Warfarin has been utilized for decades as an effective anticoagulant in patients with a history of strong risk factors for venous thromboembolism (VTE). Established adverse effects include bleeding, skin necrosis, teratogenicity during pregnancy, cholesterol embolization, and nephropathy. One of the lesser-known long-term side effects of warfarin is an increase in systemic arterial calcification. This is significant due to the association between vascular calcification and cardiovascular morbidity and mortality. Direct oral anticoagulants (DOACs) have gained prominence in recent years, as they require less frequent monitoring and have a superior side effect profile to warfarin, specifically in relation to major bleeding. The cost and lack of data for DOACs in some disease processes have precluded universal use. Within the last four years, retrospective cohort studies, observational studies, and randomized trials have shown, through different imaging modalities, that multiple DOACs are associated with slower progression of vascular calcification than warfarin. This review highlights the pathophysiology and mechanisms behind vascular calcification due to warfarin and compares the effect of warfarin and DOACs on systemic vasculature
The Effects of Warfarin and Direct Oral Anticoagulants on Systemic Vascular Calcification: A Review
Warfarin has been utilized for decades as an effective anticoagulant in patients with a history of strong risk factors for venous thromboembolism (VTE). Established adverse effects include bleeding, skin necrosis, teratogenicity during pregnancy, cholesterol embolization, and nephropathy. One of the lesser-known long-term side effects of warfarin is an increase in systemic arterial calcification. This is significant due to the association between vascular calcification and cardiovascular morbidity and mortality. Direct oral anticoagulants (DOACs) have gained prominence in recent years, as they require less frequent monitoring and have a superior side effect profile to warfarin, specifically in relation to major bleeding. The cost and lack of data for DOACs in some disease processes have precluded universal use. Within the last four years, retrospective cohort studies, observational studies, and randomized trials have shown, through different imaging modalities, that multiple DOACs are associated with slower progression of vascular calcification than warfarin. This review highlights the pathophysiology and mechanisms behind vascular calcification due to warfarin and compares the effect of warfarin and DOACs on systemic vasculature
Subcutaneous implantable cardioverterâdefibrillator noise following left ventricular assist device implantation
Abstract Background The incidence and impact of noise in a subcutaneous implantable cardioverter defibrillator (SâICD) after left ventricular assist device (LVAD) implantation is not well established. Methods We performed a retrospective study of patients implanted with LVAD and with a preâexisting SâICD between January 2005 and December 2020 at the three Mayo Clinic centers (Minnesota, Arizona, and Florida). Results Of the 908 LVAD patients, a preâexisting SâICD was present in 9 patients (mean age 49.1 ±â13.7âyears, 66.7% males), 100% with Boston Scientific thirdâgeneration EMBLEM MRI SâICD, 11% with HeartMate II (HM II), 44% with HeartMate 3 (HM 3), and 44% with HeartWare (HW) LVAD. The incidence of noise from LVADârelated electromagnetic interference (EMI) was 33% and was only seen with HM 3 LVAD. Multiple measures attempted to resolve noise, including using alternative SâICD sensing vector, adjusting SâICD time zone, and increasing LVAD pump speed, were unsuccessful, necessitating SâICD device therapies to be turned off permanently. Conclusions The incidence of LVADârelated SâICD noise is high in patients with concomitant LVAD and SâICD with significant impact on device function. As conservative management failed to resolve the EMI, the SâICDs had to be programmed off to avoid inappropriate shocks. This study highlights the importance of awareness of LVADâSICD device interference and the need to improve SâICD detection algorithms to eliminate noise