Editor,—Tsuchihashi and colleagues describe a number of interesting cases of mobile cardiac calcinosis in dialysis patients complicated by systemic thromboembolism.1However, in their discussion of possible pathophysiological mechanisms they fail to mention the possible roles of a number of calcification regulatory proteins called Gla proteins. This is a potentially important omission as it may affect management decisions regarding anticoagulation with warfarin.

Work from our laboratory and others has revealed that calcification in the vasculature is not simply a passive degenerative process as was previously thought.2 ,3 On the contrary it seems to be a highly complex and regulated process as in bone. Attention has focused on a number of proteins which appear to have regulatory roles during the calcification process and in particular on a group of these …