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Lifestyle and diet as risk factors for overanticoagulation
Fernie J A Penning-van Beest1, Johanna M Geleijnse, Erik van Meegen
1Pharmaco-epidemiology Unit, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
Insights
Overanticoagulation risk with coumarin anticoagulants increases significantly at an International Normalized Ratio (INR) > or =6.0. Lifestyle factors like low physical activity and recent alcohol reduction are key risk factors, necessitating closer INR monitoring.
Area of Science:
- Pharmacology
- Clinical Medicine
- Public Health
Background:
- Coumarin anticoagulants are crucial for preventing thromboembolic events.
- Overanticoagulation, indicated by an International Normalized Ratio (INR) > or =6.0, significantly elevates hemorrhage risk.
- Identifying factors contributing to overanticoagulation is essential for patient safety.
Purpose of the Study:
- To investigate sociodemographic, lifestyle, and dietary factors associated with overanticoagulation in outpatient anticoagulation clinic patients.
- To compare patients with INR > or =6.0 to those within the therapeutic range.
Main Methods:
- A case-control study design was employed.
- Three hundred cases with INR > or =6.0 were compared with 302 matched controls within the target INR range.
- Data collected included sociodemographic, lifestyle (physical activity, smoking, alcohol consumption), and dietary information.
Main Results:
- Negative associations were found between body mass index and overanticoagulation.
- Beneath-average physical activity and being a never-smoker were positively associated with overanticoagulation.
- Recent alcohol intake reduction, weight loss, and vacations were identified as significant risk factors.
- No association was found between habitual alcohol consumption or dietary factors and overanticoagulation.
Conclusions:
- Lifestyle factors, particularly reduced physical activity and recent changes in alcohol intake, are linked to overanticoagulation.
- Increased monitoring of INR values is recommended when identified risk factors cannot be mitigated.
- Proactive management of these risk factors can help prevent overanticoagulation and reduce bleeding complications.
Abstract:
The risk of hemorrhage when using coumarin anticoagulants sharply increases when the International Normalized Ratio (INR) is > or =6.0. We performed a case-control study among outpatients of an anticoagulation clinic to identify sociodemographic-, lifestyle-, and dietary factors related to overanticoagulation. Three hundred cases with an INR > or =6.0 were compared with 302 randomly selected matched controls with an INR within the target zone. Age, sex, and level of education were not associated with overanticoagulation. Body mass index was negatively related to overanticoagulation, a beneath-average level of physical activity was positively related to overanticoagulation and never-smokers were more likely to have an INR > or =6.0 compared with smokers. Habitual alcohol consumption, even heavy drinking, was not related to overanticoagulation. However, a recent decrease of alcohol intake increased the risk of an INR > or =6.0. In addition, weight loss and a vacation were risk factors for overanticoagulation. Dietary factors were not associated with overanticoaguation. If risk factors can not be avoided, increased monitoring of INR values could prevent overanticoagulation and potential bleeding complications.