Severe undernutrition increases bleeding risk on vitamin-K antagonists

Journal article


Moustafa, Farès, Dopeux, Loïc, Mulliez, Aurelien, Boirie, Yves, Morand, Christine, Gentes, Elodie, Farigon, Nicolas, Richard, Damien, Lebreton, Aurélien, Teissandier, Dorian, Dutheil, Frederic and Schmidt, Jeannot. (2021). Severe undernutrition increases bleeding risk on vitamin-K antagonists. Clinical Nutrition. 40(4), pp. 2237-2243. https://doi.org/10.1016/j.clnu.2020.10.002
AuthorsMoustafa, Farès, Dopeux, Loïc, Mulliez, Aurelien, Boirie, Yves, Morand, Christine, Gentes, Elodie, Farigon, Nicolas, Richard, Damien, Lebreton, Aurélien, Teissandier, Dorian, Dutheil, Frederic and Schmidt, Jeannot
Abstract

Introduction
Hemorrhage occurs in 7–10% of patients treated with vitamin K antagonist (VKA), with major bleeding in 1–3%. 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 non-bleeding 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 ± 3.7 μmol/L, p = 0.003); among them, there was a higher rate of patients with plasma zinc under 5 μmol/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.

ClinicalTrials.gov number
NCT 01742871.

Keywordsundernutrition; bleeding; anticoagulant agent; micronutrient
Year2021
JournalClinical Nutrition
Journal citation40 (4), pp. 2237-2243
PublisherElsevier B.V.
ISSN0261-5614
Digital Object Identifier (DOI)https://doi.org/10.1016/j.clnu.2020.10.002
Scopus EID2-s2.0-85092791181
Research or scholarlyResearch
Page range2237-2243
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online09 Oct 2020
Publication process dates
Accepted01 Oct 2020
Deposited14 Jul 2021
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Crendal, Edward, Dutheil, Fred, Naughton, Geraldine, McDonald, Tracey and Obert, Philippe. (2014). Increased myocardial dysfunction, dyssynchrony, and epicardial fat across the lifespan in healthy males. BMC Cardiovascular Disorders. 14(95), pp. 1 - 10. https://doi.org/10.1186/1471-2261-14-95
Atherogenic subfractions of lipoproteins in the treatment of metabolic syndrome by physical activity and diet - the RESOLVE trial
Dutheil, Frederic, Walther, Guillame, Chapier, Robert, Mnatzaganian, George, Lesourd, Bruno, Naughton, Geraldine, Verney, Julien, Fogli, Anne, Sapin, Vincent, Duclos, Martine, Vinet, Agnes, Obert, Philippe, Courteix, Daniel and Lac, Gerard. (2014). Atherogenic subfractions of lipoproteins in the treatment of metabolic syndrome by physical activity and diet - the RESOLVE trial. Lipids in Health and Disease. 13(1). https://doi.org/10.1186/1476-511X-13-112
Comparison of the ultra-low-dose Veo algorithm with the gold standard filtered back projection for detecting pulmonary asbestos-related conditions : A clinical observational study
Tekath, Marielle, Dutheil, Frederic, Bellini, Romain, Roche, Antoine, Pereira, Bruno, Naughton, Geraldine, Chamoux, Alain and Michel, Jean-Luc. (2014). Comparison of the ultra-low-dose Veo algorithm with the gold standard filtered back projection for detecting pulmonary asbestos-related conditions : A clinical observational study. BMJ Open. 4(5), pp. 1 - 8. https://doi.org/10.1136/bmjopen-2014-004980
Right ventricle free wall mechanics in metabolic syndrome without type-2 diabetes: Effects of a 3-month lifestyle intervention program
Serrano-Ferrer, Juan, Walther, Guillaume, Crendal, Edward, Vinet, Agnes, Dutheil, Frederic, Naughton, Geraldine A., Lesourd, Bruno, Chapier, Robert, Courteix, Daniel and Obert, Philippe. (2014). Right ventricle free wall mechanics in metabolic syndrome without type-2 diabetes: Effects of a 3-month lifestyle intervention program. Cardiovascular Diabetology. 13(1), pp. 1 - 11. https://doi.org/10.1186/s12933-014-0116-9
Atherogenic subfractions of lipoproteins in the treatment of metabolic syndrome by physical activity and diet : the RESOLVE trial
Dutheil, Frederic, Walther, Guillaume, Chapier, Robert, Mnatzaganian, George, Lesourd, Bruno, Naughton, Geraldine, Verney, Julien, Fogli, Anne, Sapin, Vincent and Duclose, Martine. (2014). Atherogenic subfractions of lipoproteins in the treatment of metabolic syndrome by physical activity and diet : the RESOLVE trial. Lipids in Health and Disease. 13(112), pp. 1 - 9. https://doi.org/10.1186/1476-511X-13-112
Myocardial deformation and twist mechanics in adults with metabolic syndrome : Impact of cumulative metabolic burden
Crendal, Edward, Walther, Guillaume, Vinet, Agnes, Dutheil, Frederic, Naughton, Geraldine, Lesourd, Bruno, Chapier, Robert, Rupp, Thomas, Courteix, Daniel and Obert, Philippe. (2013). Myocardial deformation and twist mechanics in adults with metabolic syndrome : Impact of cumulative metabolic burden. Obesity: a resourch journal. https://doi.org/10.1002/oby.20537
Urinary Interleukin-8 is a biomarker of stress in emergency physicians, especially with advancing age: The JOBSTRESS* randomized trial
Dutheil, Frederic, Trousselard, Marion, Perrier, Christophe, Lac, Gerard, Chamoux, Alain, Duclos, Martine, Naughton, Geraldine, Mnatzaganian, George and Schmidt, Jeannot. (2013). Urinary Interleukin-8 is a biomarker of stress in emergency physicians, especially with advancing age: The JOBSTRESS* randomized trial. PLoS ONE. 8(8), pp. 1 - 7. https://doi.org/10.1371/journal.pone.0071658
Different modalities of exercise to reduce visceral fat mass and cardiovascular risk in metabolic syndrome : the RESOLVE* randomized trial
Dutheil, Frederic, Lac, Gerard, Lesourd, Bruno, Chapier, Robert, Walther, Guillaume, Vinet, Agnes, Sapin, Vincent, Verney, Julien, Ouchchane, Lemlih and Duclos, Martine. (2013). Different modalities of exercise to reduce visceral fat mass and cardiovascular risk in metabolic syndrome : the RESOLVE* randomized trial. International Journal of Cardiology. https://doi.org/10.1016/j.ijcard.2013.05.012
The long-term effects of occupational exposure to vinyl chloride monomer on microcirculation : a cross-sectional study 15 years after retirement
Lopez, Vincent, Chamoux, Alain, Tempier, Marion, Thiel, Helene, Ughetto, Sylvie, Trousselard, Marion, Naughton, Geraldine and Dutheil, Frederic. (2013). The long-term effects of occupational exposure to vinyl chloride monomer on microcirculation : a cross-sectional study 15 years after retirement. BMJ Open. https://doi.org/10.1136/bmjopen-2013-002785
Treatment of Metabolic syndrome by combination of physical activity and diet needs an optimal protein intake: a randomized controlled trial
Dutheil, Frederic, Lac, Gerard, Courteix, Daniel, Dore, Eric, Chapier, Robert, Roszyk, Laurence, Sapin, Vincent and Lesourd, Bruno. (2012). Treatment of Metabolic syndrome by combination of physical activity and diet needs an optimal protein intake: a randomized controlled trial. Nutrition Journal. 11(1). https://doi.org/10.1186/1475-2891-11-72