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Observational Study
. 2013 Oct 28;2(6):e000364.
doi: 10.1161/JAHA.113.000364.

Vitamin E Serum Levels and Bleeding Risk in Patients Receiving Oral Anticoagulant Therapy: A Retrospective Cohort Study

Free PMC article
Observational Study

Vitamin E Serum Levels and Bleeding Risk in Patients Receiving Oral Anticoagulant Therapy: A Retrospective Cohort Study

Daniele Pastori et al. J Am Heart Assoc. .
Free PMC article


Background: Hemorrhagic risk assessment is a crucial issue in patients with nonvalvular atrial fibrillation (NVAF) who are receiving oral anticoagulant therapy (OAT). Our aim was to analyze the relationship between vitamin E, which possesses anticoagulant properties, and bleeding events in NVAF patients.

Methods and results: In this retrospective observational study we analyzed baseline serum cholesterol-adjusted vitamin E (vit E/chol) levels in 566 consecutive patients (59% males, mean age 73.6 years) receiving OAT followed up for a mean time of 22 months. Mean time in therapeutic INR range (TTR) was 64%. The overall incidence rate of any bleeding event was 9.2/100 person-years. Compared to patients who did not bleed, those who experienced bleeding events (n=92, 73 minor and 15 major bleedings and 4 cerebral hemorrhages according to International Society on Thrombosis and Haemostasis [ISTH] ) classification) showed a significant difference for history of coronary heart disease (P=0.039), HAS-BLED score (P=0.002), and vit E/chol levels (P<0.001). Higher vit E/chol serum levels were found in patients who bled compared to those who did not (5.27 ± 1.93 versus 4.48 ± 1.97 μmol/cholesterol; P<0.001), with a progressive increase from minor (5.16 ± 1.91 μmol/mmol cholesterol, P=0.006) to major bleedings (5.72 ± 2.0 μmol/mmol cholesterol, P=0.008). A Cox proportional hazard model demonstrated that serum vit E/chol quartiles (global P=0.0189) and HAS-BLED scores (P=0.005) predicted bleeding events.

Conclusions: In a NVAF population being treated with warfarin, serum vitamin E predicted hemorrhagic events. Further study is necessary to see if the relationship between serum levels of vitamin E and bleeding is still maintained with the use of new anticoagulants.

Trial registration: NCT01882114.

Keywords: anticoagulation; atrial fibrillation; bleeding; tocopherol.


Figure 1.
Figure 1.
Kaplan–Meier estimates of time to main outcome events by vitamin E quartiles.
Figure 2.
Figure 2.
Kaplan–Meier estimates of time to secondary outcome events during the follow‐up according to median baseline value of vitamin E.

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    1. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991; 22:983-988 - PubMed
    1. Lip GY, Andreotti F, Fauchier L, Huber K, Hylek E, Knight E, Lane D, Levi M, Marín F, Palareti G, Kirchhof P European Heart Rhythm Association Bleeding risk assessment and management in atrial fibrillation patients. Executive summary of a position document from the European Heart Rhythm Association [EHRA], endorsed by the European Society of Cardiology [ESC] Working Group on Thrombosis. Thromb Haemost. 2011; 106:997-1011 - PubMed
    1. Yung D, Kapral MK, Asllani E, Fang J, Lee DS Investigators of the Registry of the Canadian Stroke Network Reinitiation of anticoagulation after warfarin‐associated intracranial hemorrhage and mortality risk: the Best Practice for Reinitiating Anticoagulation Therapy After Intracranial Bleeding (BRAIN) study. Can J Cardiol. 2012; 28:33-39 - PubMed
    1. Hart RG, Boop BS, Anderson DC. Oral anticoagulants and intracranial hemorrhage. Facts and hypotheses. Stroke. 1995; 26:1471-1477 - PubMed
    1. Rosand J, Eckman MH, Knudsen KA, Singer DE, Greenberg SM. The effect of warfarin and intensity of anticoagulation on outcome of intracerebral hemorrhage. Arch Intern Med. 2004; 164:880-884 - PubMed

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