| Improved oral anticoagulation after a dietary vitamin k-guided strategy: a randomized controlled trial. | |
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MedLine Citation:
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PMID: 19738137 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Dietary vitamin K is thought to be an important factor that interferes with anticoagulation stability, but the clinical applicability of this interaction has not been evaluated adequately in prospective studies. METHODS AND RESULTS: In a randomized controlled trial that enrolled outpatients with a recent international normalized ratio (INR) outside the therapeutic target, we compared 2 strategies to optimize long-term oral anticoagulation: (1) a conventional approach based on changes in anticoagulant prescription and (2) a dietary vitamin K-guided strategy based on simple modifications of the amount of vitamin K-rich foods ingested per week. The primary efficacy end point was the percentage of patients who achieved a prespecified INR target at 90 days after randomization. Study population (n=132) predominantly included men with mechanical heart prostheses (58%) or atrial fibrillation (35%). Over time, patients allocated to the vitamin K-guided strategy reached the prespecified INR more frequently so that after 90 days of follow-up, 74% were on target compared with 58% of patients managed conventionally (P=0.04). Patients allocated to the dietary vitamin K-guided strategy had the same magnitude and direction of INR variation as those observed with the conventional approach in the short term (15 days) for both underanticaogulated and overanticoagulated patients. Minor bleeding or use of parenteral vitamin K were also marginally less frequent in patients managed according to the dietary intervention (1 [1.5%] versus 7 [11%]; P=0.06). CONCLUSIONS: A vitamin K-guided management strategy to adjust long-term oral anticoagulation is feasible and safe and may result in an increased chance of reaching target levels of INR. |
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Authors:
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Michelli C de Assis; Eneida R Rabelo; Christiane W Avila; Carisi Anne Polanczyk; Luis E Rohde |
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Publication Detail:
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Type: Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't Date: 2009-09-08 |
Journal Detail:
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Title: Circulation Volume: 120 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2009 Sep |
Date Detail:
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Created Date: 2009-09-22 Completed Date: 2009-10-08 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: 1115-22, 3 p following 1122 Citation Subset: AIM; IM |
Affiliation:
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Cardiovascular Division of Hospital de Clínicas de Porto Alegre, Postgraduation Program in Cardiology and Cardiovascular Sciences, Federal University of Rio Grande do Sul, Porto Alegre, Brazil. |
| Data Bank Information | |
Bank Name/Acc. No.:
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ClinicalTrials.gov/NCT00355290 |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Administration, Oral Adult Aged Anticoagulants / administration & dosage* Cross-Over Studies Diet Female Humans International Normalized Ratio Male Middle Aged Vitamin K / administration & dosage* |
| Chemical | |
Reg. No./Substance:
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0/Anticoagulants; 12001-79-5/Vitamin K |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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