Friday, February 16, 2018


Q: All of the following can be the  side-effects of warfarin except?

A) Bleeding 

B) Skin necrosis 
C) Teratogenicity during pregnancy
D) Cholesterol embolization 
E) Vascular de-calcification

Answer:  E

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.


1. Koos R, Mahnken AH, Mühlenbruch G, et al. Relation of oral anticoagulation to cardiac valvular and coronary calcium assessed by multislice spiral computed tomography. Am J Cardiol 2005; 96:747. 

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. 

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