Long-term Warfarin use and arterial calcification?

[ClickerTicker]

I've recently become aware that arterial calcification is a risk with warfarin use. I've been taking a high dose of warfarin for nearly 20 years to keep my artificial heart valve ticking away. My INR needs to be between 3 and 4 so I typically take in the order of 8 to 10mg daily.

I wondered if anyone had looked into arterial calcification to see if it really is much of a risk, or maybe even asked their consultant to arrange a Coronary Calcification Scan (a CT scan)?

[SpeedyH]

There seems to be plenty of studies that indicate that it is a risk. There are other factors that increase the risk too, not just warfarin so it might not be a greatly significant risk. It would probably be worth having a conversation with your cardiologist or a haematologist about this though it might be one of those things that cannot be avoided.

[Kempsh0tt]

Hi Clicker Ticker, There have been a number of papers over the years, some specifically focusing on the increased risks for women, but also recognising men too can carry the risk too.

I think the focus here should be on raising the importance of preventative care for those on Warfarin. Including a Coronary Calcification Scan (a CT scan) on the patient care pathway (every five years perhaps, or within 12 months if patients have been taking Warfarin long-term for many years would seem to be a way to reduce risks, especially where renal disorders risk further exacerbating the situation. TC

[ClickerTicker in reply to Kempsh0tt]

Thanks Kempsh0tt and SpeedyH - I like the idea of upping the importance of preventative care for us warfarin users. Will definitely raise this during my next Cardiology appointment.

Obviously a Coronary Calcification Scan would be reassuring - will see if my (NHS) consultant can be talked into referring me for one. I think they are unfortunately rationed by age and I'm probably on the wrong side of the bar on that. Still, we'll see. A private one is bound to be eye-wateringly expensive.

There is some info online that suggests that Vitamin K supplementation may reduce Coronary Calcification when warfarin is being taken. I don't consciously try to restrict Vitamin K - I eat a fair amount of green stuff and my multivitamin has K1 in it at RDA level (75mcg). Consistency is the name of the game. It may be that K2 and a bit more of it would be better than K1, but I'm worried about playing with fire - juggling higher doses of Vitamin K and warfarin. Maybe when I understand a bit more...

[Hidden]

What advantage is there in knowing the calcium score, apart from making lifestyle changes? Would you want to have an angiogram? Would you switch to a DOAC?

[ClickerTicker in reply to Hidden]

James, good question.Switching to a DOAC is not an option with a mechanical mitral valve. At least I'd know and be able to discuss future options with my cardiologist, even if that's only closer and more frequent monitoring.

I have an echo every couple of years to check the valve, not sure if those look for calcification as a matter of routine or indeed can get a good handle on it.

Anyway, as a precaution, I've starting taking a vitamin K2 (MK7) supplement - initially 100mcg, which doesn't seem to have hit my INR as much as I expected. Dropped it by about 0.5 in fact. Have upped my warfarin dose to counteract, will continue testing my INR weekly to see if it is stable.

I guess the K2 could go a bit higher if required. Am already taking a reasonable amount of D3.