Q: All of the following can be the side-effects of warfarin except?
B) Skin necrosis
C) Teratogenicity during pregnancy
D) Cholesterol embolization
E) Vascular de-calcification
Instead of vascular de-calcification, actually vascular calcification has been seen in patient on warfarin therapy. It can be seen in aortic valve, coronary arteries, femoral artery. The mechanism of action is the inhibition of a vitamin K dependent matrix Gla protein. It's correlation with clinical outcomes such as stroke or coronary events is still not validated.
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2. Koos R, Krueger T, Westenfeld R, et al. Relation of circulating Matrix Gla-Protein and anticoagulation status in patients with aortic valve calcification. Thromb Haemost 2009; 101:706.
3. Rennenberg RJ, van Varik BJ, Schurgers LJ, et al. Chronic coumarin treatment is associated with increased extracoronary arterial calcification in humans. Blood 2010; 115:5121.