Severe undernutrition increases bleeding risk on vitamin-K antagonists

Area of Science:

• Cardiology
• Nutritional Science
• Pharmacology

Background:

• Vitamin K antagonist (VKA) therapy is associated with a 7-10% incidence of hemorrhage, with 1-3% experiencing major bleeding.
• The influence of nutritional status on bleeding risk in patients receiving anticoagulants is not well-established.
• Assessing patient nutritional status may offer predictive insights for anticoagulant therapy.

Purpose of the Study:

• To investigate the association between the nutritional status of patients undergoing VKA treatment and the occurrence of hemorrhagic events.
• To analyze the status of specific micronutrients in relation to bleeding risk.

Main Methods:

• A prospective, monocentric, case-control study was conducted from August 2012 to October 2015.
• Case patients experienced major bleeding, while control patients had no bleeding events during VKA treatment.
• 294 VKA-treated patients were analyzed, paired by age, gender, and INR, with 98 (33.3%) in the major bleeding group and 196 (66.7%) in the control group.

Main Results:

• Undernutrition was prevalent in over two-thirds of patients and was more common in the bleeding group (OR=1.85).
• Severe undernutrition significantly increased bleeding risk (OR=2.66), while moderate undernutrition showed no significant difference.
• Bleeding patients exhibited lower plasma zinc levels (9.4 ± 3.6 vs. 10.5 ± 3.7 μmol/L, p=0.003), with a higher proportion having zinc levels below 5 μmol/L (9% vs. 2%, p<0.001).

Conclusions:

• Patients on VKA with undernutrition have a substantially elevated risk of bleeding, with severe undernutrition tripling this risk.
• Nutritional status evaluation provides valuable prognostic information before initiating VKA therapy.
• ClinicalTrials.gov Identifier: NCT01742871.