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Wang X, Peng L, Ma J, Zhang L, Liu J. Warfarin-Induced Calcification: Potential Prevention and Treatment Strategies. Rev Cardiovasc Med 2022; 23:322. [PMID: 39077691 PMCID: PMC11262346 DOI: 10.31083/j.rcm2309322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/06/2022] [Accepted: 06/06/2022] [Indexed: 07/31/2024] Open
Abstract
Warfarin is clinically used as the first choice for long-term anticoagulant therapy, and for the prevention of thromboembolic events. However, when used at low doses in the long term or high doses in the short term, warfarin treatment may result in tissue calcifications-such as calcifications in the coronary arteries, peripheral vascular system, blood vessels of patients with atrial fibrillation and chronic kidney disease, and vascular valves-and atherosclerotic plaque calcification. These warfarin-induced calcifications may affect cardiovascular function and exacerbate diseases such as diabetes and hypertension. Studies have shown that quercetin, osteoprotegerin, sclerosin, and sodium thiosulfate may alleviate these effects by interfering in the Wnt/ β -catenin, TG2/ β -catenin, Bone Morphogenetic Protein 2 (BMP2), and Eicosapentaenoic Acid/Matrix Metallopeptidase-9 (EPA/MMP-9) pathways, respectively. Nevertheless, the mechanism underlying warfarin-induced calcification remains unknown. Therefore, the question as to how to effectively attenuate the calcification induced by warfarin and ensure its anticoagulant effect remains an urgent clinical problem that needs to be resolved. To utilize warfarin rationally and to effectively attenuate the calcifications, we focused on the clinical phenomena, molecular mechanisms, and potential strategies to prevent calcification. Highlighting these aspects could provide new insights into the effective utilization of warfarin and the reduction of its associated calcification effects.
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Affiliation(s)
- Xiaowu Wang
- Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, 710032 Xi'an, Shaanxi, China
| | - Langang Peng
- Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, 710032 Xi'an, Shaanxi, China
| | - Jipeng Ma
- Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, 710032 Xi'an, Shaanxi, China
| | - Liyun Zhang
- Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, 710032 Xi'an, Shaanxi, China
| | - Jincheng Liu
- Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, 710032 Xi'an, Shaanxi, China
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Kawai Y, Banshodani M, Moriishi M, Shizukawa H, Sato T, Shintaku S, Masaki T, Kawanishi H. Penile calciphylaxis in patients with end-stage kidney disease undergoing dialysis: invasive treatment and pain management. Ther Apher Dial 2022; 26:950-959. [PMID: 34984854 DOI: 10.1111/1744-9987.13789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/26/2021] [Accepted: 12/29/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Penile calciphylaxis is rarely reported in dialysis patients. METHODS We experienced cases of dialysis patients who had penile calciphylaxis between 2003 and 2020. RESULTS Seven patients undergoing dialysis were treated for penile necrosis (hemodialysis [HD], 5; peritoneal dialysis [PD], 1; hybrid therapy comprising PD and HD, 1). Their mean age was 62.8 years and their mean dialysis vintage 116.1 months. All had severe penile pain and were clinically diagnosed with calciphylaxis. Four received partial penectomy and three received percutaneous transluminal angioplasty (PTA) due to rapid aggravation. The number of analgesia types and the critical-care pain observation tool score significantly decreased after invasive treatment (both, P = 0.008). The 90-day and 1-year survival rates after onset were 85.7% and 57.1%, respectively. CONCLUSION In dialysis patients, penile calciphylaxis has poor prognosis; however, invasive treatments for pain management are effective. PTA may be beneficial in dialysis patients in poor condition. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yusuke Kawai
- Artificial Organs, Akane Foundation, Tsuchiya General Hospital 3-30, Nakajimacho, Naka-ku, Hiroshima, Japan
| | - Masataka Banshodani
- Artificial Organs, Akane Foundation, Tsuchiya General Hospital 3-30, Nakajimacho, Naka-ku, Hiroshima, Japan
| | - Misaki Moriishi
- Artificial Organs, Akane Foundation, Tsuchiya General Hospital 3-30, Nakajimacho, Naka-ku, Hiroshima, Japan
| | - Hiroko Shizukawa
- Dermatology, Akane Foundation, Tsuchiya General Hospital 3-30, Nakajimacho, Naka-ku, Hiroshima, Japan
| | - Tomoyasu Sato
- Radiology, Akane Foundation, Tsuchiya General Hospital 3-30, Nakajimacho, Naka-ku, Hiroshima, Japan
| | - Sadanori Shintaku
- Artificial Organs, Akane Foundation, Tsuchiya General Hospital 3-30, Nakajimacho, Naka-ku, Hiroshima, Japan
| | - Takao Masaki
- Department of Nephrology, Hiroshima University Hospital 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan
| | - Hideki Kawanishi
- Artificial Organs, Akane Foundation, Tsuchiya General Hospital 3-30, Nakajimacho, Naka-ku, Hiroshima, Japan
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Penile calciphylaxis diagnosis and treatment challenges a case report. Int J Surg Case Rep 2020; 77:187-190. [PMID: 33166817 PMCID: PMC7652709 DOI: 10.1016/j.ijscr.2020.10.097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 11/24/2022] Open
Abstract
Rarity of this presentation. Controversies on treatment. Controversies about diagnosis.
Introduction Painful tip penile ischemic lesion that varies from ulceration to dry gangrene which is calcified in a patient with ESRD on chronic dialysis is a seriously complicated disease due to microvascular disease of subcutaneous and adipose tissue. Case presentation 72 gentleman who is on chronic dialysis for the last 8 years because of ESRD, In which he developed many vascular disease and amputation done for him presented with spreading black painful areas at the tip of the glans for which conservative treatment took place for about month. Discussion The diagnosis and management of this rare disease still unclear. Diagnosis mostly clinical, treatment conservative versus surgical. Conclusion Controversies of for penile Calciphylaxis diagnosis and treatment for its rarity, high mortality rate, and as its part of systematic disease treatment till know individualized according to patient status and extent of the necrotic area.
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