The impact of acute diarrhea on the coagulation status of patients with vitamin K antagonists
Abstract Acute diarrhea is associated with a reduced absorption of both vitamin K antagonists (VKA) and vitamin K itself. To date, the net effect on the coagulation status of subjects with VKA remains elusive. We performed a systematic retrospective single-center analysis using an electronic data ex...
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2021-06-01
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doaj-d53271a1551d4b7097a455c1797549f42021-06-06T11:40:32ZengNature Publishing GroupScientific Reports2045-23222021-06-011111710.1038/s41598-021-91316-xThe impact of acute diarrhea on the coagulation status of patients with vitamin K antagonistsJohannes Schweinfurth0Alexander Bauer1Frederic Bauer2Felix Sebastian Seibert3Benjamin Rohn4Maximilian Seidel5Sebastian Bertram6Ulrik Stervbo7Nina Babel8Timm Henning Westhoff9Medical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University BochumMedical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University BochumMedical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University BochumMedical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University BochumMedical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University BochumMedical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University BochumMedical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University BochumMedical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University BochumMedical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University BochumMedical Department I, Marien Hospital Herne, University Hospital of the Ruhr-University BochumAbstract Acute diarrhea is associated with a reduced absorption of both vitamin K antagonists (VKA) and vitamin K itself. To date, the net effect on the coagulation status of subjects with VKA remains elusive. We performed a systematic retrospective single-center analysis using an electronic data extraction approach to identify subjects with plasmatic anticoagulation (either VKA or direct oral anticoagulant (DOAC)) and diarrhea in a German University Hospital over a period of eight years. Acute diarrhea and complete documentation of coagulation status on admission were defined as inclusion criteria, anticoagulation other than VKA/DOAC and obvious inadherence as exclusion criteria. Subjects with VKA/DOAC admitted for hypertension served as control group. Data extraction yielded 356 subjects with gastrointestinal diagnoses and 198 hypertensive subjects, 55 and 83 of whom fulfilled all in- and exclusion criteria. INR values of subjects with VKA were significantly higher in subjects with diarrhea than in hypertensive controls (4.3 ± 3.7 vs. 2.3 ± 0.7, p < 0.001). The distribution of subjects having INR values lower, higher or within the target range differed significantly among groups with a substantially higher prevalence of overanticoagulation in the diarrhea group (46.4% vs. 14.3%, p < 0.001). In a multinomial logistic regression model, acute diarrhea was significantly associated with overanticoagulation (odds ratio 7.2, 95% confidence interval 2.163–23.921; p < 0.001), whereas age, sex, creatinine, and indication of anticoagulation were not (p > 0.05 each). Acute diarrhea is associated with a highly increased risk for overanticoagulation in patients with VKA. Thus, gastroenteritis necessitates a close monitoring of INR in order to identify subjects needing a temporary pause of VKA therapy.https://doi.org/10.1038/s41598-021-91316-x |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Johannes Schweinfurth Alexander Bauer Frederic Bauer Felix Sebastian Seibert Benjamin Rohn Maximilian Seidel Sebastian Bertram Ulrik Stervbo Nina Babel Timm Henning Westhoff |
spellingShingle |
Johannes Schweinfurth Alexander Bauer Frederic Bauer Felix Sebastian Seibert Benjamin Rohn Maximilian Seidel Sebastian Bertram Ulrik Stervbo Nina Babel Timm Henning Westhoff The impact of acute diarrhea on the coagulation status of patients with vitamin K antagonists Scientific Reports |
author_facet |
Johannes Schweinfurth Alexander Bauer Frederic Bauer Felix Sebastian Seibert Benjamin Rohn Maximilian Seidel Sebastian Bertram Ulrik Stervbo Nina Babel Timm Henning Westhoff |
author_sort |
Johannes Schweinfurth |
title |
The impact of acute diarrhea on the coagulation status of patients with vitamin K antagonists |
title_short |
The impact of acute diarrhea on the coagulation status of patients with vitamin K antagonists |
title_full |
The impact of acute diarrhea on the coagulation status of patients with vitamin K antagonists |
title_fullStr |
The impact of acute diarrhea on the coagulation status of patients with vitamin K antagonists |
title_full_unstemmed |
The impact of acute diarrhea on the coagulation status of patients with vitamin K antagonists |
title_sort |
impact of acute diarrhea on the coagulation status of patients with vitamin k antagonists |
publisher |
Nature Publishing Group |
series |
Scientific Reports |
issn |
2045-2322 |
publishDate |
2021-06-01 |
description |
Abstract Acute diarrhea is associated with a reduced absorption of both vitamin K antagonists (VKA) and vitamin K itself. To date, the net effect on the coagulation status of subjects with VKA remains elusive. We performed a systematic retrospective single-center analysis using an electronic data extraction approach to identify subjects with plasmatic anticoagulation (either VKA or direct oral anticoagulant (DOAC)) and diarrhea in a German University Hospital over a period of eight years. Acute diarrhea and complete documentation of coagulation status on admission were defined as inclusion criteria, anticoagulation other than VKA/DOAC and obvious inadherence as exclusion criteria. Subjects with VKA/DOAC admitted for hypertension served as control group. Data extraction yielded 356 subjects with gastrointestinal diagnoses and 198 hypertensive subjects, 55 and 83 of whom fulfilled all in- and exclusion criteria. INR values of subjects with VKA were significantly higher in subjects with diarrhea than in hypertensive controls (4.3 ± 3.7 vs. 2.3 ± 0.7, p < 0.001). The distribution of subjects having INR values lower, higher or within the target range differed significantly among groups with a substantially higher prevalence of overanticoagulation in the diarrhea group (46.4% vs. 14.3%, p < 0.001). In a multinomial logistic regression model, acute diarrhea was significantly associated with overanticoagulation (odds ratio 7.2, 95% confidence interval 2.163–23.921; p < 0.001), whereas age, sex, creatinine, and indication of anticoagulation were not (p > 0.05 each). Acute diarrhea is associated with a highly increased risk for overanticoagulation in patients with VKA. Thus, gastroenteritis necessitates a close monitoring of INR in order to identify subjects needing a temporary pause of VKA therapy. |
url |
https://doi.org/10.1038/s41598-021-91316-x |
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