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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