Erythrocyte folate and 5-methyltetrahydrofolate levels decline during 6 months of oral anticoagulation with warfarin
Erythrocyte folate and 5-methyltetrahydrofolate levels decline during 6 months of oral anticoagulation with warfarin
Dietary fluctuations of vitamin K are detrimental to oral anticoagulant control. Attempts to improve control through the avoidance of vitamin K-rich foods (mainly green vegetables) may inadvertently compromise folate status, itself a risk factor for thromboembolism. We evaluated the effect of a 6-month period of warfarin therapy on folate status in 114 patients using measurements of red-cell folate and 5-methyltetrahydrofolate and plasma folate and total homocysteine. Circulatory levels of phylloquinone, vitamin B12 and methylmalonic acid were also determined. A subset of 45 patients completed 7-day food diaries at the beginning and end of their treatment. There was a significant decrease in total erythrocyte folate (P = 0.005) and 5-methyltetrahydrofolate (P = 0.002) during the study. A concurrent increase in plasma phylloquinone (P = 0.003) was attributed to warfarin-induced perturbation of vitamin K metabolism. No other longitudinal changes were observed. Folate and phylloquinone intakes correlated with each other at baseline (P = 0.024) and after treatment (P = 0.011). Based on robust measurements of erythrocyte folates, patients showed a significant impairment in folate status after 6-month therapy with warfarin. The majority of patients had intakes of folate and phylloquinone below the national average or UK guidelines. The study highlights the need for improved dietary management of patients taking oral anticoagulants.
Administration, Oral, Adult, Anticoagulants/administration & dosage, Dietary Supplements, Erythrocytes/metabolism, Female, Folic Acid/blood, Humans, Male, Middle Aged, Risk Factors, Tetrahydrofolates/blood, Thromboembolism/blood, Time Factors, United Kingdom, Vitamin K/administration & dosage, Vitamins/administration & dosage, Warfarin/administration & dosage
297-302
Sobczyńska-Malefora, Agata
8887e6df-c8e4-4b94-8788-a9645c421627
Harrington, Dominic J
efa56037-894f-4305-8245-1f67ee4896e3
Lomer, Miranda C E
8d85c0a9-6619-4da0-bd35-32383107d058
Pettitt, Claire
d43e087b-2e68-47fa-ae63-139c127d94d6
Hamilton, Sophie
8011e200-f1cf-4ddf-9718-5ff0f3428840
Rangarajan, Savita
9a5e4c7e-55ba-4a3a-b5f6-f1e269d927c3
Shearer, Martin J
c3211e4e-dbcd-4780-a952-867dac2cf862
June 2009
Sobczyńska-Malefora, Agata
8887e6df-c8e4-4b94-8788-a9645c421627
Harrington, Dominic J
efa56037-894f-4305-8245-1f67ee4896e3
Lomer, Miranda C E
8d85c0a9-6619-4da0-bd35-32383107d058
Pettitt, Claire
d43e087b-2e68-47fa-ae63-139c127d94d6
Hamilton, Sophie
8011e200-f1cf-4ddf-9718-5ff0f3428840
Rangarajan, Savita
9a5e4c7e-55ba-4a3a-b5f6-f1e269d927c3
Shearer, Martin J
c3211e4e-dbcd-4780-a952-867dac2cf862
Sobczyńska-Malefora, Agata, Harrington, Dominic J, Lomer, Miranda C E, Pettitt, Claire, Hamilton, Sophie, Rangarajan, Savita and Shearer, Martin J
(2009)
Erythrocyte folate and 5-methyltetrahydrofolate levels decline during 6 months of oral anticoagulation with warfarin.
Blood Coagulation & Fibrinolysis, 20 (4), .
(doi:10.1097/MBC.0b013e32832aa6a1).
Abstract
Dietary fluctuations of vitamin K are detrimental to oral anticoagulant control. Attempts to improve control through the avoidance of vitamin K-rich foods (mainly green vegetables) may inadvertently compromise folate status, itself a risk factor for thromboembolism. We evaluated the effect of a 6-month period of warfarin therapy on folate status in 114 patients using measurements of red-cell folate and 5-methyltetrahydrofolate and plasma folate and total homocysteine. Circulatory levels of phylloquinone, vitamin B12 and methylmalonic acid were also determined. A subset of 45 patients completed 7-day food diaries at the beginning and end of their treatment. There was a significant decrease in total erythrocyte folate (P = 0.005) and 5-methyltetrahydrofolate (P = 0.002) during the study. A concurrent increase in plasma phylloquinone (P = 0.003) was attributed to warfarin-induced perturbation of vitamin K metabolism. No other longitudinal changes were observed. Folate and phylloquinone intakes correlated with each other at baseline (P = 0.024) and after treatment (P = 0.011). Based on robust measurements of erythrocyte folates, patients showed a significant impairment in folate status after 6-month therapy with warfarin. The majority of patients had intakes of folate and phylloquinone below the national average or UK guidelines. The study highlights the need for improved dietary management of patients taking oral anticoagulants.
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Published date: June 2009
Keywords:
Administration, Oral, Adult, Anticoagulants/administration & dosage, Dietary Supplements, Erythrocytes/metabolism, Female, Folic Acid/blood, Humans, Male, Middle Aged, Risk Factors, Tetrahydrofolates/blood, Thromboembolism/blood, Time Factors, United Kingdom, Vitamin K/administration & dosage, Vitamins/administration & dosage, Warfarin/administration & dosage
Identifiers
Local EPrints ID: 443323
URI: http://eprints.soton.ac.uk/id/eprint/443323
ISSN: 0957-5235
PURE UUID: bca91e78-5c39-46e1-94d4-667a5d1ecbf1
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Date deposited: 20 Aug 2020 16:33
Last modified: 17 Mar 2024 04:02
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Author:
Agata Sobczyńska-Malefora
Author:
Dominic J Harrington
Author:
Miranda C E Lomer
Author:
Claire Pettitt
Author:
Sophie Hamilton
Author:
Martin J Shearer
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