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Improved oral anticoagulation after a dietary vitamin k-guided strategy: a randomized controlled trial.
Circulation. 2009 Sep 22; 120(12):1115-22, 3 p following 1122.Circ

Abstract

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.

Authors+Show Affiliations

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.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19738137

Citation

de Assis, Michelli C., et al. "Improved Oral Anticoagulation After a Dietary Vitamin K-guided Strategy: a Randomized Controlled Trial." Circulation, vol. 120, no. 12, 2009, pp. 1115-22, 3 p following 1122.
de Assis MC, Rabelo ER, Avila CW, et al. Improved oral anticoagulation after a dietary vitamin k-guided strategy: a randomized controlled trial. Circulation. 2009;120(12):1115-22, 3 p following 1122.
de Assis, M. C., Rabelo, E. R., Avila, C. W., Polanczyk, C. A., & Rohde, L. E. (2009). Improved oral anticoagulation after a dietary vitamin k-guided strategy: a randomized controlled trial. Circulation, 120(12), 1115-22, 3 p following 1122. https://doi.org/10.1161/CIRCULATIONAHA.109.849208
de Assis MC, et al. Improved Oral Anticoagulation After a Dietary Vitamin K-guided Strategy: a Randomized Controlled Trial. Circulation. 2009 Sep 22;120(12):1115-22, 3 p following 1122. PubMed PMID: 19738137.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Improved oral anticoagulation after a dietary vitamin k-guided strategy: a randomized controlled trial. AU - de Assis,Michelli C, AU - Rabelo,Eneida R, AU - Avila,Christiane W, AU - Polanczyk,Carisi Anne, AU - Rohde,Luis E, Y1 - 2009/09/08/ PY - 2009/9/10/entrez PY - 2009/9/10/pubmed PY - 2009/10/9/medline SP - 1115-22, 3 p following 1122 JF - Circulation JO - Circulation VL - 120 IS - 12 N2 - 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. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/19738137/Improved_oral_anticoagulation_after_a_dietary_vitamin_k_guided_strategy:_a_randomized_controlled_trial_ L2 - https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.109.849208?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -