Center of Atherothrombosis, I Medical Clinic, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Umberto I Policlinico of Rome, Rome, Italy.
J Am Heart Assoc. 2013 Oct 28;2(6):e000364. doi: 10.1161/JAHA.113.000364.
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.
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.
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.
在接受口服抗凝药物治疗（OAT）的非瓣膜性房颤（NVAF）患者中，出血风险评估是一个关键问题。我们的目的是分析具有抗凝特性的维生素 E 与 NVAF 患者出血事件之间的关系。
在这项回顾性观察研究中，我们分析了 566 例连续接受 OAT 治疗的患者（59%为男性，平均年龄 73.6 岁）的基线血清胆固醇调整维生素 E（vit E/chol）水平，平均随访时间为 22 个月。治疗国际标准化比值（TTR）范围内的平均时间为 64%。任何出血事件的总发生率为 9.2/100 人年。与未出血的患者相比，发生出血事件（n=92，73 例为轻度出血，15 例为重度出血，根据国际血栓和止血学会[ISTH]分类有 4 例为脑出血）的患者在冠心病病史（P=0.039）、HAS-BLED 评分（P=0.002）和 vit E/chol 水平（P<0.001）方面存在显著差异。与未出血的患者相比，出血的患者血清 vit E/chol 水平更高（5.27 ± 1.93 与 4.48 ± 1.97 μmol/胆固醇；P<0.001），从轻度出血（5.16 ± 1.91 μmol/mmol 胆固醇，P=0.006）到重度出血（5.72 ± 2.0 μmol/mmol 胆固醇，P=0.008）逐渐增加。Cox 比例风险模型表明，血清 vit E/chol 四分位数（整体 P=0.0189）和 HAS-BLED 评分（P=0.005）预测出血事件。
在接受华法林治疗的 NVAF 人群中，血清维生素 E 预测出血事件。需要进一步研究以确定在使用新型抗凝剂时，血清维生素 E 水平与出血之间的关系是否仍然存在。
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