Juniper Publishers-Global Journal of Pharmacy & Pharmaceutical Sciences

Juniper Publishers-Open Access Journal of Pharmacy & Pharmaceutical Sciences

Effect of Vitamin E on the Anti-Coagulant Response



Authored by Ludivine Lechevretel

Fluindione is the most used Vitamin K antagonists in France. It has been sparsely studied and few interactions have been reported with food sources. This case reveals a significant rise in INR when fluindione was associated to fatty acid (palmitic/oleic/linoleic acid 2g/day) or vitamin E (1g/day). 80-year-old male (weight 74 kg, body surface area 1.91 m²) with a history of severe allergic drug eruption documented with low molecular weight heparins, vancomycin, rifamycin and netromycin was treated and stabilized (International Normalized Ratio (INR) = 3.5) with fluindione (10 to 15 mg once per day) for cardiovascular risks due to a mechanical aortic heart valve and an aortic tube. During hospitalization, the patient stopped eating dietary supplements containing fatty acids and vitamin E (Day 0), and then, presented an imbalance of the INR (Day 2: INR = 3.5 / Day 2: INR = 1.2). An unexpected anticoagulant response (INR up 1.1 to 3.7) on fluindione was observed after administration on vitamin E (1000mg once per day) for the same patient. Analyzes performed by high-performance liquid chromatography on dietary supplements reveal low dose of α/γ/δ-tocophérol (22/0.5/0.3 mg/day respectively) and unexpected high dose of fatty acid (2 g opd containing 13/22/56% of palmitic/oleic/linoleic acid respectively). No genetic variability in the VKORC1 and CYP2C9 could be identified. The patient plasma concentration of vitamin K was 328 ng/L (normal value: 150-900 ng/L).


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