| Over-the-counter vitamin K1-containing multivitamin supplements disrupt warfarin anticoagulation in vitamin K1-depleted patients. A prospective, controlled trial. | |
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MedLine Citation:
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PMID: 15543329 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Most multivitamin supplements contain far less vitamin K(1) than thought to affect warfarin anticoagulation. Having described 3 patients with multivitamin-warfarin interactions, we hypothesized that vitamin K(1)-depleted patients are sensitive to even small increments. Therefore, we compared the effect of a vitamin K(1)-containing multivitamin on warfarin anticoagulation between patients with low versus normal vitamin K(1) status. We screened 102 warfarin-treated patients and recruited nine with "low" (< 1.5 mcg/L, 10(th) percentile) (group 1) and 7 with "normal" (>4.5 mcg/L, median) (group 2) total vitamin K(1) plasma levels (vitamin K(1) + vitamin K(1) 2,3-epoxide). Patients received one multivitamin tablet containing 25 mcg of vitamin K(1) daily, for 4 weeks (period 1). A predefined algorithm was used to adjust warfarin doses if the INR was outside the therapeutic range. Patients requiring warfarin increments were then switched to 4 weeks of a vitamin K(1)-free multivitamin supplement (period 2). During period 1, subtherapeutic INRs occurred in 9/9 and 1/7 patients in group 1 and 2, respectively (p <0.001). In group 1, INR decreased by a median of 0.51 (p <0.01), and warfarin dose had to be raised by 5.3% (p <0.01), whereas INR and warfarin dose did not change significantly in group 2. During period 2 (7 patients), there were trends towards decreased total vitamin K(1) and rising INRs associated with significantly lower warfarin doses. We conclude that vitamin K(1)-containing multivitamins reduce INR in patients with low vitamin K(1) status. Our study suggests that vitamin K-depleted patients are sensitive to even small changes in vitamin K(1) intake. |
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Authors:
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Daniel Kurnik; Ronen Loebstein; Hadas Rabinovitz; Naomi Austerweil; Hillel Halkin; Shlomo Almog |
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Publication Detail:
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Type: Clinical Trial; Controlled Clinical Trial; Journal Article |
Journal Detail:
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Title: Thrombosis and haemostasis Volume: 92 ISSN: 0340-6245 ISO Abbreviation: Thromb. Haemost. Publication Date: 2004 Nov |
Date Detail:
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Created Date: 2004-11-15 Completed Date: 2005-05-24 Revised Date: 2008-11-21 |
Medline Journal Info:
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Nlm Unique ID: 7608063 Medline TA: Thromb Haemost Country: Germany |
Other Details:
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Languages: eng Pagination: 1018-24 Citation Subset: IM |
Affiliation:
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The Division of Clinical Pharmacology and Toxicology and Anticoagulation Clinic, Sheba Medical Center, Tel Hashomer, Israel. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Anticoagulants / antagonists & inhibitors, pharmacokinetics, therapeutic use Dietary Supplements Drug Antagonism Drug Monitoring Female Humans International Normalized Ratio Male Middle Aged Nonprescription Drugs Vitamin K 1 / blood, pharmacology* Vitamin K Deficiency* Warfarin / administration & dosage*, antagonists & inhibitors, pharmacokinetics* |
| Chemical | |
Reg. No./Substance:
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0/Anticoagulants; 0/Nonprescription Drugs; 81-81-2/Warfarin; 84-80-0/Vitamin K 1 |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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