Document Detail


Erythrocyte folate and 5-methyltetrahydrofolate levels decline during 6 months of oral anticoagulation with warfarin.
MedLine Citation:
PMID:  19349858     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Dietary fluctuations of vitamin K are detrimental to oral anticoagulant control. Attempts to improve control through the avoidance of vitamin K-rich foods (mainly green vegetables) may inadvertently compromise folate status, itself a risk factor for thromboembolism. We evaluated the effect of a 6-month period of warfarin therapy on folate status in 114 patients using measurements of red-cell folate and 5-methyltetrahydrofolate and plasma folate and total homocysteine. Circulatory levels of phylloquinone, vitamin B12 and methylmalonic acid were also determined. A subset of 45 patients completed 7-day food diaries at the beginning and end of their treatment. There was a significant decrease in total erythrocyte folate (P = 0.005) and 5-methyltetrahydrofolate (P = 0.002) during the study. A concurrent increase in plasma phylloquinone (P = 0.003) was attributed to warfarin-induced perturbation of vitamin K metabolism. No other longitudinal changes were observed. Folate and phylloquinone intakes correlated with each other at baseline (P = 0.024) and after treatment (P = 0.011). Based on robust measurements of erythrocyte folates, patients showed a significant impairment in folate status after 6-month therapy with warfarin. The majority of patients had intakes of folate and phylloquinone below the national average or UK guidelines. The study highlights the need for improved dietary management of patients taking oral anticoagulants.
Authors:
Agata Sobczyńska-Malefora; Dominic J Harrington; Miranda C E Lomer; Claire Pettitt; Sophie Hamilton; Savita Rangarajan; Martin J Shearer
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis     Volume:  20     ISSN:  1473-5733     ISO Abbreviation:  Blood Coagul. Fibrinolysis     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-06-12     Completed Date:  2009-08-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9102551     Medline TA:  Blood Coagul Fibrinolysis     Country:  England    
Other Details:
Languages:  eng     Pagination:  297-302     Citation Subset:  IM    
Affiliation:
Centre for Haemostasis and Thrombosis, St Thomas' Hospital, London, UK. agata.malefora@gstt.nhs.uk
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MeSH Terms
Descriptor/Qualifier:
Administration, Oral
Adult
Anticoagulants / administration & dosage*,  adverse effects
Dietary Supplements
Erythrocytes / metabolism*
Female
Folic Acid / blood*
Great Britain
Humans
Male
Middle Aged
Risk Factors
Tetrahydrofolates / blood*
Thromboembolism / blood,  drug therapy
Time Factors
Vitamin K / administration & dosage,  blood*
Vitamins / administration & dosage,  blood*
Warfarin / administration & dosage*,  adverse effects
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Tetrahydrofolates; 0/Vitamins; 12001-79-5/Vitamin K; 134-35-0/5-methyltetrahydrofolate; 59-30-3/Folic Acid; 81-81-2/Warfarin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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