DIETARY IMPACT ON THE ANTICOAGULANT EFFICACY OF VITAMIN K ANTAGONISTS
Abstract
Background: The vitamin K antagonists’ (VKA) mechanism of action is closely related to the metabolic pathways of vitamin K. Dietary vitamin K intake can directly translate into efficacy of VKA therapy.
Aim: The aim of the study was to summarize information about the role of vitamin K in the coagulation process and its impact on Vitamin K Antagonists.
Material and methods: A non-systematic litrerature review was conducted using databases such as Pubmed and Cochrane Database. Search terms included VKA pharmacokinetics, INR targets and dietary management strategies.
Results: Irregular intake of vitamin K negatively affects the action of hydroxycoumarin derivatives by causing INR fluctuations and subtherapeutic anticoagulation. Excessive doses of vitamin K reduce VKA activity and increase risk of side effects such as thromboembolic complications.
Conclusions: Effective anticoagulation with VKAs requires personalized dosage, regular INR monitoring and conscious management of vitamin K intake.
References
Roemer-Ślimak R. A patient requiring anticoagulant therapy at a primary care physician's office.. Lekarz POZ. 2022;8(4):303-308.
Heestermans M, Poenou G, Hamzeh-Cognasse H, Cognasse F, Bertoletti L. Anticoagulants: A Short History, Their Mechanism of Action, Pharmacology, and Indications. Cells. 2022 Oct 13;11(20):3214. doi: 10.3390/cells11203214. PMID: 36291080; PMCID: PMC9600347.
Kluch, Małgorzata & Gorska-Ciebiada, Malgorzata & Łokieć, Katarzyna. (2018). The importance of diet in the prevention of adverse reactions to vitamin K-dependent anticoagulants. Polski merkuriusz lekarski: organ Polskiego Towarzystwa Lekarskiego. 45.
Linh, Nguyen & Ma, Yen & Chinh, Phạm & Tuyet, Thi & Thanh, Nga & Tran, Ninh & Khanh, Thi & Quynh, Hoa & Vu, Oanh. (2022). Original The Stability of Vitamin K in The Diet of Patients Using Oral Anticoagulant Vitamin K Antagonist (VKA) Drugs in Hanoi Medical University Hospital in 2021. 03. 2021.
Přemysl Mladěnka, Kateřina Macáková, Lenka Kujovská Krčmová, Lenka Javorská, Kristýna Mrštná, Alejandro Carazo, Michele Protti, Fernando Remião, Lucie Nováková, the OEMONOM researchers and collaborators, Vitamin K – sources, physiological role, kinetics, deficiency, detection, therapeutic use, and toxicity, Nutrition Reviews, Volume 80, Issue 4, April 2022, Pages 677–698, https://doi.org/10.1093/nutrit/nuab061
Andrzej Mital, Magdalena Łętowska, Krzysztof Chojnowski, Anna Klukowska, Jacek Musiał, Maria Podolak-Dawidziak, Jarosław Peregud-Pogorzelski, Jacek Treliński, Anetta Undas, Jerzy Windyga, Joanna Zdziarska, Krystyna Zawilska. Polish recommendations for treatment with vitamin K antagonists. Journal of Transfusion Medicine 2013;6(2):41-47, 10.5603/jtm.35062
Fawzy AM, Lip GYH. Pharmacokinetics and pharmacodynamics of oral anticoagulants used in atrial fibrillation. Expert Opin Drug Metab Toxicol. 2019 May;15(5):381-398. doi: 10.1080/17425255.2019.1604686. Epub 2019 Apr 19. PMID: 30951640.
National Center for Biotechnology Information (2025). PubChem Compound Summary for CID 54676537, Acenocoumarol. Retrieved June 12, 2025 from https://pubchem.ncbi.nlm.nih.gov/compound/Acenocoumarol.
Ufer, Mike. (2005). Comparative Pharmacokinetics of Vitamin K Antagonists: Warfarin, Phenprocoumon and Acenocoumarol. Clinical pharmacokinetics. 44. 1227-46.
Schalekamp T, van Geest-Daalderop JH, de Vries-Goldschmeding H, Conemans J, Bernsen Mj Mj, de Boer A. Acenocoumarol stabilization is delayed in CYP2C93 carriers. Clin Pharmacol Ther. 2004 May;75(5):394-402. doi: 10.1016/j.clpt.2003.12.017. PMID: 15116052.
Haustein KO. Pharmacokinetic and pharmacodynamic properties of oral anticoagulants, especially phenprocoumon. Semin Thromb Hemost. 1999;25(1):5-11. doi: 10.1055/s-2007-996417. PMID: 10327214.
Husted, S., Andreasen, F. Individual variation in the response to phenprocoumon. Eur J Clin Pharmacol 11, 351–358 (1977). https://doi.org/10.1007/BF00566532
Botton MR, Viola PP, Bandinelli E, Leiria TL, Rohde LE, Hutz MH. A new algorithm for weekly phenprocoumon dose variation in a southern Brazilian population: role for CYP2C9, CYP3A4/5 and VKORC1 gene polymorphisms. Basic Clin Pharmacol Toxicol. 2014 Apr;114(4):323-9. doi: 10.1111/bcpt.12172. Epub 2013 Dec 7. PMID: 24224579.
Dorgalaleh A, Favaloro EJ, Bahraini M, Rad F. Standardization of Prothrombin Time/International Normalized Ratio (PT/INR). Int J Lab Hematol. 2021 Feb;43(1):21-28. doi: 10.1111/ijlh.13349. Epub 2020 Sep 26. PMID: 32979036.
Zhang J, Chen Z, Chen C. Impact of CYP2C9, VKORC1 and CYP4F2 genetic polymorphisms on maintenance warfarin dosage in Han-Chinese patients: A systematic review and meta-analysis. Meta Gene. 2016 Jul 5;9:197-209. doi: 10.1016/j.mgene.2016.07.002. PMID: 27617219; PMCID: PMC5006145.
Jarosz M. (red.): Normy żywienia dla populacji polskiej – nowelizacja. Instytut Żywności i Żywienia, Warszawa, 2012: 114-115.
Bułhak-Jachymczyk B., Witaminy, [w:] Normy żywienia człowieka. Podstawy prewencji otyłości i chorób niezakaźnych, [red.] M. Jarosz, B. Bułhak-Jachymczyk, IŻŻ, PZWL, Warszawa, 2008, 172-232.
Schurgers LJ, Vermeer C. Determination of phylloquinone and menaquinones in food. Effect of food matrix on circulating vitamin K concentrations. Haemostasis 2000;30:298-307
Booth SL. Vitamin K: food composition and dietary intakes. Food Nutr Res. 2012;56. doi: 10.3402/fnr.v56i0.5505. Epub 2012 Apr 2. PMID: 22489217; PMCID: PMC3321250.
Peterson JW, Muzzey KL, Haytowitz D, Exler J, Lemar L, Booth SL. Phylloquinone (vitamin K-1) and dihydrophylloquinone content of fats and oils. JAOCS 2002; 79: 6416.
HARRIS, JANICE. (1995). Interaction of Dietary Factors with Oral Anticoagulants. Journal of the American Dietetic Association. 95. 580-4. 10.1016/S0002-8223(95)00158-1.
Booth SL, Pennington JA, Sadowski JA. Dihydro-vitamin K1: primary food sources and estimated dietary intakes in the American diet. Lipids. 1996 Jul;31(7):715-20. doi: 10.1007/BF02522887. PMID: 8827694.
Booth, Sarah & Al Rajabi, Ala. (2008). Determinants of Vitamin K Status in Humans. Vitamins and hormones. 78. 1-22. 10.1016/S0083-6729(07)00001-5.
Park JN, Lee JS, Noh MY, Sung MK. Association Between Usual Vitamin K Intake and Anticoagulation in Patients Under Warfarin Therapy. Clin Nutr Res. 2015 Oct;4(4):235-41. doi: 10.7762/cnr.2015.4.4.235. Epub 2015 Oct 31. PMID: 26566518; PMCID: PMC4641985.
Holmes MV, Hunt BJ, Shearer MJ. The role of dietary vitamin K in the management of oral vitamin K antagonists. Blood Rev. 2012 Jan;26(1):1-14. doi: 10.1016/j.blre.2011.07.002. Epub 2011 Sep 13. PMID: 21914559.
Rombouts, Eva & Rosendaal, Frits & Meer, Felix. (2010). Influence of dietary vitamin K intake on subtherapeutic oral anticoagulant therapy. British journal of haematology. 149. 598-605. 10.1111/j.1365-2141.2010.08108.x.
Sconce, Elizabeth & Avery, Peter & Wynne, Hilary & Kamali, Farhad. (2007). Vitamin K supplementation can improve stability of anticoagulation for patients with unexplained variability in response to warfarin. Blood. 109. 2419-23. 10.1182/blood-2006-09-049262.
Violi F, Lip GY, Pignatelli P, Pastori D. Interaction Between Dietary Vitamin K Intake and Anticoagulation by Vitamin K Antagonists: Is It Really True?: A Systematic Review. Medicine (Baltimore). 2016 Mar;95(10):e2895. doi: 10.1097/MD.0000000000002895. PMID: 26962786; PMCID: PMC4998867.
Johnson JA, Cavallari LH. Warfarin pharmacogenetics. Trends in Cardiovascular Medicine. 2015;25(1):33-41. doi:10.1016/j.tcm.2014.09.001
Presse, Nancy & Kergoat, Marie-Jeanne & Ferland, Guylaine. (2011). High usual dietary vitamin K intake is associated with low relative variability in vitamin K intake: Implications for anticoagulant therapy. British journal of haematology. 153. 129-30. 10.1111/j.1365-2141.2010.08537.x.
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