New Insights Into the Pros and Cons of Anticoagulation Therapy

Nutrients, an international, peer-reviewed journal for studies related to Human Nutrition, recently published a review that updates on oral anticoagulant (OAC) treatment on the vasculature with a special focus on calcification and vitamin K interaction. Most importantly, the review includes the recently developed alternative anticoagulant drugs – direct oral anticoagulants (DOACs) – which researchers deem a safer alternative as they do not pose the negative side effects that typically accompany OACs.

Vitamin K-antagonists (VKA) are the most widely used anticoagulant drugs to treat patients at risk of arterial and venous thrombosis for the past 50 years. Due to unfavorable pharmacokinetics, VKAs have a small therapeutic window, require frequent monitoring, and are susceptible to drug and nutritional interactions. According to researchers of a new paper published in Nutrients, the most notable interaction is vitamin K, which may lead to increased arterial calcification.

The limitations of VKAs stimulated the development of alternative anticoagulant drugs, resulting in DOACs, which specifically targeting coagulation factor Xa and thrombin more consistently. Further, DOACs do not present nutrient interaction, such as vitamin K, and therefore may actually have benefits for coronary artery disease.

Treating patients with hypercoagulability and vascular disease requires personalized medicine. The effect of VKAs is not limited to coagulation, but affects all vitamin K-dependent proteins (VKDP). As a consequence, VKA have detrimental side effects by enhancing medial and intimal calcification,” says Dr. Katarzyna Maresz, president of the International Science and Health Foundation.

In the new paper, the authors suggest that direct oral anticoagulant (DOAC) treatment in combination with supplemental vitamin K administration has the potential to prevent both hypercoagulability and inhibit vascular calcification.

“While the effects of DOACs on vascular calcification are not known yet, it is unlikely to affect VKDP activity, as DOACs specifically target coagulation factor Xa and thrombin. This is promising,” Dr. Maresz continues. “High intake of vitamin K has shown to inhibit and even reverse warfarin-induced vascular calcification in experimental animals and in adenine treated rats. It is tempting to speculate that co-administration of vitamin K with anticoagulation therapy can target both coagulation and calcification.”

Reference:

van Gorp RH, Schurgers LJ. New Insights into the Pros and Cons of the Clinical Use of Vitamin K Antagonists (VKAs) Versus Direct Oral Anticoagulants (DOACs). Nutrients 2015, 7, 1–20; doi:10.3390/nu7115479.

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