Severe undernutrition increases bleeding risk on vitamin-K antagonists
Résumé
Introduction. Hemorrhage occurs in 7 to 10% of patients treated with vitamin K
antagonist (VKA), with major bleeding in 1 to 3%. Impact of nutritional status on the
bleeding risk of patients on anticoagulants is still poorly documented. Our study aimed
to analyze the link between the nutritional status of patients on VKA and the occurrence
of hemorrhagic events. We also analyzed micronutrients status.
Methods. A case-control, monocentric, and prospective study was conducted from
August 2012 to October 2015. The case patients were those presenting with major
bleeding and control patients those without any bleeding under VKA treatment.
Results. Overall, 294 patients under VKA treatment were paired according to age,
gender, and index normalized ratio (INR). Out of these, 98 (33.3%) had major bleeding
and 196 (66.7%) did not have any bleeding. Additionally, more than two-thirds of
patients displayed undernutrition, which was more prevalent in bleeding than nonbleeding patients (OR = 1.85, CI95%: 1.07 - 3.21). There was a higher bleeding risk
for those with severe undernutrition (OR = 2.66, CI95%: 1.58 - 4.46), with no difference
found concerning moderate undernutrition. Bleeding patients had lower plasma-zinc
concentrations than non-bleeding patients (9.4±3.6 vs. 10.5±3.7µmol/L, p = 0.003);
among them, there was a higher rate of patients with plasma zinc under 5µmol/L (9%
vs. 2%, p <0.001).
Conclusion. Patients with undernutrition on VKA exhibit a significantly higher bleeding
risk, which increases three-fold in case of severe undernutrition. The evaluation of
nutritional status provides additional, valuable prognosis information prior to initiating
VKA therapy.
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