Luca Di Lullo1, Giovanni Tripepi2, Claudio Ronco3, Graziella D'Arrigo2, Vincenzo Barbera4, Domenico Russo5, Biagio Raffaele Di Iorio6, Massimo Uguccioni7, Ernesto Paoletti8, Maura Ravera8, Maria Fusaro9, Antonio Bellasi10. 1. Department of Nephrology and Dialysis, Parodi-Delfino Hospital, Colleferro, Rome, Italy. Electronic address: dilulloluca69@gmail.com. 2. Institute of Clinical Physiology, Research Unit of Reggio Calabria, National Research Council (IFC-CNR), Reggio Calabria, Italy. 3. International Renal Research Institute, S. Bortolo Hospital, Vicenza, Italy. 4. Department of Nephrology and Dialysis, Parodi-Delfino Hospital, Colleferro, Rome, Italy. 5. Department of Public Health, Federico II University, Napoli, Italy. 6. Department of Nephrology and Dialysis, AORN "Antonio Cardarelli", Napoli, Italy. 7. Department of Cardiology, S. Camillo Hospital, Roma, Italy. 8. Department of Nephrology and Dialysis, S. Martino Hospital, Genova, Italy. 9. Department of Medicine, University of Padova, Italy. 10. Department of Research, Innovation and Brand Reputation, ASST Papa Giovanni XXIII, Bergamo, Italy. Electronic address: abellasi@asst-pg23.it.
Abstract
AIMS: Direct oral anticoagulant (DOAC) has been recently introduced in the clinical practice. Rather than interfering with vitamin K-dependent posttranscriptional modification of various proteins, DOACs selectively inhibit factors involved in the coagulation cascade. In particular, in contrast with Warfarin, Rivaroxabn does not interfere with activation of matrix Gla Protein (MGP), a potent vascular calcification Inhibitor. We herein sought to investigate the impact of Rivaroxaban and Warfarin on cardiac valve calcifications in a cohort of moderate-to advanced CKD patients. METHODS AND RESULTS: This is a multicenter, observational, retrospective, longitudinal study. Consecutive CKD stage 3b - 4 (according to KDIGO guidelines) patients from 8 cardiologic outpatient clinics were enrolled between May 2015 and October 2017. All patients received anticoagulation (100 Warfarin vs 247 Rivaroxaban) as part of their non-valvular atrial fibrillation management. Cardiac valve calcification was evaluated via standard trans-thoracic echocardiogram. 347 patients (mean age: 66 years; mean eGFR: 37 ml/min/1.73 m2) were studied. Over a mean follow-up period of 16 months, Rivaroxaban compared to Warfarin reduced both mitral and aortic valve calcifications (p < 0.001) independently of the degree of calcifications at baseline and potential confounders. Notably, Rivaroxaban use was also associated with a significant reduction in C reactive protein (CRP) (p < 0.001) during follow-up. CONCLUSION: This study generates the hypothesis that the use of Rivaroxaban associates with a reduction of cardiac valve calcification deposition and progression as compared to Warfarin, in a cohort of CKD stage 3b-4 patients. Future endeavors are needed to confirm and to establish the mechanisms responsible for these findings.
AIMS: Direct oral anticoagulant (DOAC) has been recently introduced in the clinical practice. Rather than interfering with vitamin K-dependent posttranscriptional modification of various proteins, DOACs selectively inhibit factors involved in the coagulation cascade. In particular, in contrast with Warfarin, Rivaroxabn does not interfere with activation of matrix Gla Protein (MGP), a potent vascular calcification Inhibitor. We herein sought to investigate the impact of Rivaroxaban and Warfarin on cardiac valve calcifications in a cohort of moderate-to advanced CKDpatients. METHODS AND RESULTS: This is a multicenter, observational, retrospective, longitudinal study. Consecutive CKD stage 3b - 4 (according to KDIGO guidelines) patients from 8 cardiologic outpatient clinics were enrolled between May 2015 and October 2017. All patients received anticoagulation (100 Warfarin vs 247 Rivaroxaban) as part of their non-valvular atrial fibrillation management. Cardiac valve calcification was evaluated via standard trans-thoracic echocardiogram. 347 patients (mean age: 66 years; mean eGFR: 37 ml/min/1.73 m2) were studied. Over a mean follow-up period of 16 months, Rivaroxaban compared to Warfarin reduced both mitral and aortic valve calcifications (p < 0.001) independently of the degree of calcifications at baseline and potential confounders. Notably, Rivaroxaban use was also associated with a significant reduction in C reactive protein (CRP) (p < 0.001) during follow-up. CONCLUSION: This study generates the hypothesis that the use of Rivaroxaban associates with a reduction of cardiac valve calcification deposition and progression as compared to Warfarin, in a cohort of CKD stage 3b-4 patients. Future endeavors are needed to confirm and to establish the mechanisms responsible for these findings.
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Authors: Antonio Bellasi; Luca Di Lullo; Domenico Russo; Roberto Ciarcia; Michele Magnocavallo; Carlo Lavalle; Carlo Ratti; Maria Fusaro; Mario Cozzolino; Biagio Raffaele Di Iorio Journal: J Clin Med Date: 2021-01-20 Impact factor: 4.241
Authors: Essa Hariri; Nicholas Kassis; Jean-Pierre Iskandar; Leon J Schurgers; Anas Saad; Omar Abdelfattah; Agam Bansal; Toshiaki Isogai; Serge C Harb; Samir Kapadia Journal: Open Heart Date: 2021-11
Authors: Antonio Bellasi; Luca Di Lullo; Domenico Russo; Roberto Ciarcia; Michele Magnocavallo; Carlo Lavalle; Carlo Ratti; Mario Cozzolino; Biagio Raffaele Di Iorio Journal: Cells Date: 2021-05-03 Impact factor: 6.600