The Experts below are selected from a list of 258 Experts worldwide ranked by ideXlab platform
Wafaie W Fawzi - One of the best experts on this subject based on the ideXlab platform.
-
Active Tuberculosis in HIV-Exposed Tanzanian Children up to 2 years of Age: Early-Life Nutrition, Multivitamin Supplementation and Other Potential Risk Factors.
Journal of Tropical Pediatrics, 2015Co-Authors: Ibironke Olofin, Said Aboud, Donna Spiegelman, Karim P Manji, Christopher Duggan, Goodarz Danaei, Wafaie W FawziAbstract:Over half a million children worldwide develop active tuberculosis (TB) each year. Early-life nutritional exposures have rarely been examined in relation to pediatric TB among HIV-exposed children. We therefore investigated independent associations of early-life nutritional exposures with active TB among HIV-exposed children up to 2 years of age.Participants were children from a randomized controlled Multivitamin supplementation trial conducted in Dar es Salaam, Tanzania, from August 2004 to May 2008, who received daily Multivitamin Supplements or placebo for 24 months.Lower mean corpuscular volumes [relative risks (RR): 0.48, 95% confidence interval (CI): 0.27, 0.87] and higher birth weights (RR: 0.61, 95% CI: 0.37, 0.99) were protective against active TB, whereas Multivitamin supplementation was not associated with TB risk (RR: 0.87, 95% CI: 0.65, 1.16).Knowledge of nutrition-related risk and protective factors for TB in HIV-exposed children could enhance preventive and case-finding activities in this population, contributing to efforts to reduce the global TB burden.
-
effect of Multivitamin Supplements on weight gain during pregnancy among hiv negative women in tanzania
Maternal and Child Nutrition, 2015Co-Authors: Freeman T Changamire, Donna Spiegelman, Gernard I Msamanga, Ramadhani S Mwiru, Karen E Peterson, Paul Petraro, Willy Urassa, Wafaie W FawziAbstract:Multivitamin supplementation has been shown to reduce the risk of low birthweight. This effect could be mediated through gestational weight gain. However the effect of Multivitamin supplementation on weight gain during pregnancy has not been fully studied. The objective of this study was to examine the effects of Multivitamins on pregnancy weight gain. We enrolled 8468 HIV-negative women from Dar es Salaam Tanzania in a randomized placebo-controlled trial of Multivitamins on birth outcomes. Women were randomly assigned to receive either a daily oral dose of Multivitamin tablets or a placebo and were weighed every 4 weeks from enrolment until the last visit before delivery. Intent-to-treat analyses were carried out to examine the effects of Multivitamins on pregnancy weight gain. Multivariate linear and binomial regression models with the log-link function were used to examine the association of weight gain during pregnancy to birthweight. The overall total weight gain was 253 g (SE: 69 P: 0.0003) more while the overall 4 weekly weight gain was 59 g greater (SE: 18 P: 0.005) among women who received Multivitamins compared to placebo. Women in the lowest quartile of gestational weight gain had babies with an average birthweight of 3030 g (SD: 524) while women in the highest quartile had babies weighing 3246 g (SD: 486) on average. Prenatal Multivitamin Supplements increased gestational weight gain which was a significant predictor of birthweight.
-
Multivitamin supplementation improves haematologic status in children born to HIV-positive women in Tanzania
Journal of the International AIDS Society, 2013Co-Authors: Christopher Duggan, Roland Kupka, Said Aboud, James Okuma, Karim P Manji, Ronald J Bosch, Roderick R Kisenge, Wafaie W FawziAbstract:Introduction: Anaemia is prevalent among children born to HIV-positive women, and it is associated with adverse effects on cognitive and motor development, growth, and increased risks of morbidity and mortality. Objective: To examine the effect of daily Multivitamin supplementation on haematologic status and mother-to-child transmission (MTCT) of HIV through breastfeeding. Methods: A total of 2387 infants born to HIV-positive women from Dar es Salaam, Tanzania were enrolled in a randomized, double-blind, placebo-controlled trial, and provided a daily oral supplement of Multivitamins (vitamin B complex, C and E) or placebo at age 6 weeks for 24 months. Among them, 2008 infants provided blood samples and had haemoglobin concentrations measured at baseline and during a follow-up period. Anaemia was defined as haemoglobin concentrations B11 g/dL and severe anaemia B8.5 g/dL. Results: Haemoglobin concentrations among children in the treatment group were significantly higher than those in the placebo group at 12 (9.77 vs. 9.64 g/dL, p0.03), 18 (9.76 vs. 9.57 g/dL, p0.004), and 24 months (9.93 vs. 9.75 g/dL, p0.02) of follow-up. Compared to those in the placebo group, children in the treatment group had a 12% lower risk of anaemia (hazard ratio (HR): 0.88; 95% CI: 0.790.99; p0.03). The treatment was associated with a 28% reduced risk of severe anaemia among children born to women without anaemia (HR: 0.72; 95% CI: 0.560.92; p0.008), but not among those born to women with anaemia (HR: 1.10; 95% CI: 0.791.54; p0.57; p for interaction0.007). One thousand seven hundred fifty three infants who tested HIV-negative at baseline and had HIV testing during follow-up were included in the analysis for MTCT of HIV. No association was found between Multivitamin Supplements and MTCT of HIV. Conclusions: Multivitamin Supplements improve haematologic status among children born to HIV-positive women. Further trials focusing on anaemia among HIV-exposed children are warranted in the context of antiretroviral therapy.
-
Effect of Multivitamin Supplementation on Measles Vaccine Response among HIV-Exposed Uninfected Tanzanian Infants
Clinical and Vaccine Immunology, 2013Co-Authors: Christopher R. Sudfeld, Said Aboud, Karim P Manji, Christopher Duggan, Molin Wang, Alex Histed, Simin Nikbin Meydani, Edward Giovannucci, Wafaie W FawziAbstract:Immunization and nutritional interventions are mainstays of child health programs in sub-Saharan Africa, yet few published data exist on their interactions. HIV-exposed (but uninfected) infants enrolled in a randomized placebo-controlled trial of Multivitamin Supplements (vitamins B complex, C, and E) conducted in Tanzania were sampled for an assessment of measles IgG quantity and avidity at 15 to 18 months. Infants were vaccinated between 8.5 and 12 months of age, and all mothers received high-dose Multivitamins as the standard of care. Of 201 HIV-exposed infants who were enrolled, 138 (68.7%) were seropositive for measles. There were no effects of infant Multivitamin supplementation on measles seroconversion proportions, IgG concentrations, or IgG avidity (P>0.05). The measles seroconversion proportion was greater for HIV-exposed infants vaccinated at 10 to 11 months of age than for those vaccinated at 8.5 to 10 months (P0.032) and greater for infants whose mothers had a CD4 T-cell count of 350 cells/l(P0.039). Stunted infants had a significantly decreased IgG quantity compared to nonstunted infants (P0.012). As for measles avidity, HIV-exposed infants vaccinated at 10 to 11 months had increased antibody avidity compared to those vaccinated at 8.5 to 10 months (P0.031). Maternal CD4 T-cell counts of 350 cells/l(P0.047), as were lower infant height-for-age z-scores (P0.016). Supplementation with Multivitamins containing B complex, C, and E does not appear to improve measles vaccine responses for HIV-exposed infants. Studies are needed to better characterize the impact of maternal HIV disease severity on the immune system development of HIV-exposed infants and the effect of malnutrition interventions on vaccine responses. (This study has been registered at ClinicalTrials.gov under registration no. NCT00197730.)
-
Multivitamin Supplements have no effect on growth of tanzanian children born to hiv infected mothers
Journal of Nutrition, 2013Co-Authors: Roland Kupka, Said Aboud, James Okuma, Wafaie W Fawzi, Karim P Manji, Ronald J Bosch, Rodrick Kisenge, Christopher DugganAbstract:Growth faltering and micronutrient deficiencies commonly coexist in HIV-exposed children in sub-Saharan Africa, and correcting deficiencies, such as those of vitamins B-complex, C, and E, may improve HIV-related endpoints and child growth. We therefore examined the effect of daily oral supplementation of vitamins B-complex, C, and E on growth among 2341 children born to HIV-infected mothers in Tanzania. HIV-infected women pregnant at ≤32 wk of gestation were enrolled in the study. Children were randomized at age 6 wk to receive Multivitamins or placebo until age 104 wk. All women received the same types of vitamins pre- and postnatally. At 6 wk, 256 children (11.1%) were HIV infected and the mean (SD) Z-scores for length for age (LAZ), weight for length (WLZ), and weight for age (WAZ) were −0.39 ± 1.20, −0.21 ± 1.23, and −0.52 ± 1.11, respectively. There was no overall treatment effect on LAZ, WLZ, or WAZ profiles during the follow-up (P ≥ 0.15). There was no treatment effect from 6 to 104 wk on LAZ [(95% CI: −0.14, 0.13); P = 0.94], WLZ [(95% CI: −0.17, 0.13); P = 0.78], or WAZ [(95% CI: −0.15, 0.16); P = 0.97] or on the incidence of growth failure, defined as respective Z-scores < −2 (P ≥ 0.29). Among the subgroup of HIV-uninfected children, there was no treatment effect from 6 to 104 wk on LAZ, WLZ, and WAZ (P ≥ 0.71) or on the incidence of growth failure (P ≥ 0.16). Multivitamin Supplements had no effect on growth among children born to HIV-infected women who were themselves receiving Multivitamins.
David J Erickson - One of the best experts on this subject based on the ideXlab platform.
-
autosomal trisomy and maternal use of Multivitamin Supplements
American Journal of Medical Genetics, 2004Co-Authors: Lorenzo D Botto, Joseph Mulinare, Quanhe Yang, David J EricksonAbstract:Recent reports suggest that women carrying certain polymorphisms of folate genes associated with suboptimal folate status might be at increased risk for having a child with Down syndrome or other autosomal trisomies, and hypothesized that maternal use of Multivitamin Supplements might reduce such risk. To evaluate this hypothesis, we examined data from a population-based case-control study, and contrasted cases of Down syndrome, trisomy 18, and trisomy 13, with unaffected controls. Periconceptional Multivitamin use, compared to no such use, was associated with an odds ratio (OR) of 0.9 (95% confidence interval [CI], 0.6–1.3) for having a pregnancy affected by an autosomal trisomy. The OR was 0.8 (95% CI, 0.5–1.3) for Down syndrome and 1.4 (95% CI, 0.5–3.6) for trisomies 13 and 18, with little variation by maternal race or age. Periconceptional Multivitamin use was not associated with a major reduction in the risk for common autosomal trisomies. Published 2003 Wiley-Liss, Inc.
-
do Multivitamin or folic acid Supplements reduce the risk for congenital heart defects evidence and gaps
American Journal of Medical Genetics Part A, 2003Co-Authors: Lorenzo D Botto, Joseph Mulinare, David J EricksonAbstract:Congenital heart defects are among the most common congenital anomalies and are the leading cause of infant death due to congenital anomalies. Except for a few known measures, effective primary prevention is not yet feasible for most heart anomalies. Recent reports have associated the use of Multivitamin Supplements around the time of conception and during early pregnancy with a reduced risk for heart defects in the offspring. We review and discuss the evidence and suggest a framework for further investigation in this area.
-
do Multivitamin Supplements attenuate the risk for diabetes associated birth defects
Pediatrics, 2003Co-Authors: Adolfo Correa, Lorenzo D Botto, Joseph Mulinare, David J EricksonAbstract:Objective. To evaluate whether the risk for birth defects associated with maternal diabetes is attenuated by use of Multivitamin Supplements during the periconceptional period. Methods. In the population-based Atlanta Birth Defects Case-Control Study, we identified case infants who had nonsyndromic birth defects that were reported to be associated with diabetes ( n = 3278) and were born during 1968–1980 to residents of metropolitan Atlanta. Controls were infants without birth defects ( n = 3029). Maternal diabetes was defined as reported diabetes with onset before the date of birth of the index infant, and periconceptional use of Multivitamins was defined as reported regular use of Multivitamin Supplements from 3 months before pregnancy through the first 3 months of pregnancy. Results. Offspring of mothers with diabetes had an increased risk for selected birth defects. However, the increased risk was limited to offspring of mothers who had diabetes and had not taken Multivitamins during the periconceptional period (odds ratio: 3.93; 95% confidence interval: 1.79–8.63). Offspring of mothers who had diabetes and had taken Multivitamins during the periconceptional period had no increased risk for birth defects (odds ratio: 0.15; 95% confidence interval: 0.00–1.99). Conclusions. Periconceptional use of Multivitamin Supplements may reduce the risk for birth defects among offspring of mothers with diabetes.
Lorenzo D Botto - One of the best experts on this subject based on the ideXlab platform.
-
Do Multivitamin Supplements attenuate the risk for diabetes-associated birth defects?
Pediatrics, 2020Co-Authors: Adolfo Correa, Lorenzo D Botto, Joseph Mulinare, J David EricksonAbstract:To evaluate whether the risk for birth defects associated with maternal diabetes is attenuated by use of Multivitamin Supplements during the periconceptional period. In the population-based Atlanta Birth Defects Case-Control Study, we identified case infants who had nonsyndromic birth defects that were reported to be associated with diabetes (n = 3278) and were born during 1968-1980 to residents of metropolitan Atlanta. Controls were infants without birth defects (n = 3029). Maternal diabetes was defined as reported diabetes with onset before the date of birth of the index infant, and periconceptional use of Multivitamins was defined as reported regular use of Multivitamin Supplements from 3 months before pregnancy through the first 3 months of pregnancy. Offspring of mothers with diabetes had an increased risk for selected birth defects. However, the increased risk was limited to offspring of mothers who had diabetes and had not taken Multivitamins during the periconceptional period (odds ratio: 3.93; 95% confidence interval: 1.79-8.63). Offspring of mothers who had diabetes and had taken Multivitamins during the periconceptional period had no increased risk for birth defects (odds ratio: 0.15; 95% confidence interval: 0.00-1.99). Periconceptional use of Multivitamin Supplements may reduce the risk for birth defects among offspring of mothers with diabetes.
-
Autosomal trisomy and maternal use of Multivitamin Supplements.
American journal of medical genetics. Part A, 2004Co-Authors: Lorenzo D Botto, Joseph Mulinare, Quanhe Yang, J David EricksonAbstract:Recent reports suggest that women carrying certain polymorphisms of folate genes associated with suboptimal folate status might be at increased risk for having a child with Down syndrome or other autosomal trisomies, and hypothesized that maternal use of Multivitamin Supplements might reduce such risk. To evaluate this hypothesis, we examined data from a population-based case-control study, and contrasted cases of Down syndrome, trisomy 18, and trisomy 13, with unaffected controls. Periconceptional Multivitamin use, compared to no such use, was associated with an odds ratio (OR) of 0.9 (95% confidence interval [CI], 0.6-1.3) for having a pregnancy affected by an autosomal trisomy. The OR was 0.8 (95% CI, 0.5-1.3) for Down syndrome and 1.4 (95% CI, 0.5-3.6) for trisomies 13 and 18, with little variation by maternal race or age. Periconceptional Multivitamin use was not associated with a major reduction in the risk for common autosomal trisomies.
-
autosomal trisomy and maternal use of Multivitamin Supplements
American Journal of Medical Genetics, 2004Co-Authors: Lorenzo D Botto, Joseph Mulinare, Quanhe Yang, David J EricksonAbstract:Recent reports suggest that women carrying certain polymorphisms of folate genes associated with suboptimal folate status might be at increased risk for having a child with Down syndrome or other autosomal trisomies, and hypothesized that maternal use of Multivitamin Supplements might reduce such risk. To evaluate this hypothesis, we examined data from a population-based case-control study, and contrasted cases of Down syndrome, trisomy 18, and trisomy 13, with unaffected controls. Periconceptional Multivitamin use, compared to no such use, was associated with an odds ratio (OR) of 0.9 (95% confidence interval [CI], 0.6–1.3) for having a pregnancy affected by an autosomal trisomy. The OR was 0.8 (95% CI, 0.5–1.3) for Down syndrome and 1.4 (95% CI, 0.5–3.6) for trisomies 13 and 18, with little variation by maternal race or age. Periconceptional Multivitamin use was not associated with a major reduction in the risk for common autosomal trisomies. Published 2003 Wiley-Liss, Inc.
-
do Multivitamin or folic acid Supplements reduce the risk for congenital heart defects evidence and gaps
American Journal of Medical Genetics Part A, 2003Co-Authors: Lorenzo D Botto, Joseph Mulinare, David J EricksonAbstract:Congenital heart defects are among the most common congenital anomalies and are the leading cause of infant death due to congenital anomalies. Except for a few known measures, effective primary prevention is not yet feasible for most heart anomalies. Recent reports have associated the use of Multivitamin Supplements around the time of conception and during early pregnancy with a reduced risk for heart defects in the offspring. We review and discuss the evidence and suggest a framework for further investigation in this area.
-
do Multivitamin Supplements attenuate the risk for diabetes associated birth defects
Pediatrics, 2003Co-Authors: Adolfo Correa, Lorenzo D Botto, Joseph Mulinare, David J EricksonAbstract:Objective. To evaluate whether the risk for birth defects associated with maternal diabetes is attenuated by use of Multivitamin Supplements during the periconceptional period. Methods. In the population-based Atlanta Birth Defects Case-Control Study, we identified case infants who had nonsyndromic birth defects that were reported to be associated with diabetes ( n = 3278) and were born during 1968–1980 to residents of metropolitan Atlanta. Controls were infants without birth defects ( n = 3029). Maternal diabetes was defined as reported diabetes with onset before the date of birth of the index infant, and periconceptional use of Multivitamins was defined as reported regular use of Multivitamin Supplements from 3 months before pregnancy through the first 3 months of pregnancy. Results. Offspring of mothers with diabetes had an increased risk for selected birth defects. However, the increased risk was limited to offspring of mothers who had diabetes and had not taken Multivitamins during the periconceptional period (odds ratio: 3.93; 95% confidence interval: 1.79–8.63). Offspring of mothers who had diabetes and had taken Multivitamins during the periconceptional period had no increased risk for birth defects (odds ratio: 0.15; 95% confidence interval: 0.00–1.99). Conclusions. Periconceptional use of Multivitamin Supplements may reduce the risk for birth defects among offspring of mothers with diabetes.
Hillel Halkin - One of the best experts on this subject based on the ideXlab platform.
-
Over-the-counter vitamin K1-containing Multivitamin Supplements disrupt warfarin anticoagulation in vitamin K1-depleted patients
Thrombosis and Haemostasis, 2020Co-Authors: Daniel Kurnik, Ronen Loebstein, Shlomo Almog, Hadas Rabinovitz, Naomi Austerweil, Hillel HalkinAbstract:SummaryMost Multivitamin Supplements contain far less vitamin K1 than thought to affect warfarin anticoagulation. Having described 3 patients with Multivitamin-warfarin interactions, we hypothesized that vitamin K1–depleted patients are sensitive to even small increments. Therefore, we compared the effect of a vitamin K1-containing Multivitamin on warfarin anticoagulation between patients with low versus normal vitamin K1 status. We screened 102 warfarin-treated patients and recruited nine with “low” (< 1.5 mcg/L, 10th percentile) (group 1) and 7 with “normal” (>4.5 mcg/L, median) (group 2) total vitamin K1 plasma levels (vitamin K1 + vitamin K1 2,3-epoxide). Patients received one Multivitamin tablet containing 25 mcg of vitamin K1 daily, for 4 weeks (period 1). A predefined algorithm was used to adjust warfarin doses if the INR was outside the therapeutic range. Patients requiring warfarin increments were then switched to 4 weeks of a vitamin K1-free Multivitamin supplement (period 2). During period 1, subtherapeutic INRs occurred in 9/9 and 1/7 patients in group 1 and 2, respectively (p <0.001). In group 1, INR decreased by a median of 0.51 (p <0.01), and warfarin dose had to be raised by 5.3% (p <0.01), whereas INR and warfarin dose did not change significantly in group 2. During period 2 (7 patients), there were trends towards decreased total vitamin K1 and rising INRs associated with significantly lower warfarin doses. We conclude that vitamin K1-containing Multivitamins reduce INR in patients with low vitamin K1 status. Our study suggests that vitamin Kdepleted patients are sensitive to even small changes in vitamin K1 intake.
-
Multivitamin Supplements may affect warfarin anticoagulation in susceptible patients.
Annals of Pharmacotherapy, 2020Co-Authors: Daniel Kurnik, Aharon Lubetsky, Ronen Loebstein, Shlomo Almog, Hillel HalkinAbstract:OBJECTIVE:To report an interaction of a Multivitamin preparation containing small amounts of vitamin K1 (25 μg) with warfarin in a case series and to assess the prevalence of vitamin K1 deficiency in ambulatory anticoagulated patients.CASE SUMMARIES:We describe 3 patients whose anticoagulation was stabilized with warfarin in whom initiation or cessation of a self-prescribed Multivitamin supplement delivering 25 μg of vitamin K1 daily was associated with an otherwise unexplained significant fall or rise in international normalized ratio (INR), respectively, with major thrombosis or hemorrhage in 2. This interaction was rated probable on the Naranjo probability scale. Suspecting vitamin K1 deficiency as an explanation for this oversensitivity, we assessed the prevalence of vitamin K1 deficiency in our clinic by determining plasma vitamin K1 levels in 179 stable consecutive patients, finding very low levels (
-
over the counter vitamin k1 containing Multivitamin Supplements disrupt warfarin anticoagulation in vitamin k1 depleted patients a prospective controlled trial
Thrombosis and Haemostasis, 2004Co-Authors: Daniel Kurnik, Ronen Loebstein, Hillel Halkin, Hadas Rabinovitz, Naomi Austerweil, Shlomo AlmogAbstract:: Most Multivitamin Supplements contain far less vitamin K(1) than thought to affect warfarin anticoagulation. Having described 3 patients with Multivitamin-warfarin interactions, we hypothesized that vitamin K(1)-depleted patients are sensitive to even small increments. Therefore, we compared the effect of a vitamin K(1)-containing Multivitamin on warfarin anticoagulation between patients with low versus normal vitamin K(1) status. We screened 102 warfarin-treated patients and recruited nine with "low" ( 4.5 mcg/L, median) (group 2) total vitamin K(1) plasma levels (vitamin K(1) + vitamin K(1) 2,3-epoxide). Patients received one Multivitamin tablet containing 25 mcg of vitamin K(1) daily, for 4 weeks (period 1). A predefined algorithm was used to adjust warfarin doses if the INR was outside the therapeutic range. Patients requiring warfarin increments were then switched to 4 weeks of a vitamin K(1)-free Multivitamin supplement (period 2). During period 1, subtherapeutic INRs occurred in 9/9 and 1/7 patients in group 1 and 2, respectively (p <0.001). In group 1, INR decreased by a median of 0.51 (p <0.01), and warfarin dose had to be raised by 5.3% (p <0.01), whereas INR and warfarin dose did not change significantly in group 2. During period 2 (7 patients), there were trends towards decreased total vitamin K(1) and rising INRs associated with significantly lower warfarin doses. We conclude that vitamin K(1)-containing Multivitamins reduce INR in patients with low vitamin K(1) status. Our study suggests that vitamin K-depleted patients are sensitive to even small changes in vitamin K(1) intake.
-
Over-the-counter vitamin K1-containing Multivitamin Supplements disrupt warfarin anticoagulation in vitamin K1-depleted patients A prospective, controlled trial
Thrombosis and Haemostasis, 2004Co-Authors: Daniel Kurnik, Ronen Loebstein, Hillel Halkin, Hadas Rabinovitz, Naomi Austerweil, Shlomo AlmogAbstract:Most Multivitamin Supplements contain far less vitamin K 1 than thought to affect warfarin anticoagulation. Having described 3 patients with Multivitamin-warfarin interactions, we hypothesized that vitamin K 1 -depleted patients are sensitive to even small increments. Therefore, we compared the effect of a vitamin K 1 -containing Multivitamin on warfarin anticoagulation between patients with low versus normal vitamin K, status.We screened 102 warfarin-treated patients and recruited nine with low ( 4.5 mcg/L, median) (group 2) total vitamin K 1 plasma levels (vitamin K 1 + vitamin K 1 2,3-epoxide). Patients received one Multivitamin tablet containing 25 mcg of vitamin K 1 daily, for 4 weeks (period I). A predefined algorithm was used to adjust warfarin doses if the INR was outside the therapeutic range. Patients requiring warfarin increments were then switched to 4 weeks of a vitamin K 1 -free Multivitamin supplement (period 2). During period I, subtherapeutic INRs occurred in 9/9 and 1/7 patients in group I and 2, respectively (p
-
over the counter vitamin k1 containing Multivitamin Supplements disrupt oral anticoagulation in susceptible patients a prospective trial
Clinical Pharmacology & Therapeutics, 2004Co-Authors: Daniel Kurnik, Ronen Loebstein, Shlomo Almog, Hadas Rabinovitz, Naomi Austerweil, Hillel HalkinAbstract:Background Most over-the counter Multivitamin Supplements (MV) contain far less vitamin K1 (VK) than amounts considered to affect oral anticoagulation. We have described 3 cases in whom a MV containing 25 μg VK lowered INR with severe clinical complications, suggesting that patients with low VK plasma levels are sensitive to even small VK Supplements. Aim To determine whether a MV (Centrum Plus®, 25 μg VK) affects warfarin anticoagulation, depending on baseline plasma VK. Methods Distribution of total plasma VK levels (vitamin K1 + K1-epoxide) was determined in 100 stable ambulatory patients at therapeutic INRs. 9 patients with “low” ( 4.5 ng/ml, median) levels received 1 daily tablet of Centrum Plus® for 4 weeks, with twice weekly INR control. Outcomes were: (1) need for warfarin dose change in response to subtherapeutic INR (<2.0 or <2.5 by target INR) (2) mean daily warfarin dose and mean INR on MV compared with baseline. Results In patients with low vs. normal VK, respectively, dose increases were required in 9/9 and 1/7 (p 10%, at any visit during the study period, was 5.2 (95% CI, 3.1–8.2). Mean INR decreased (by 0.45, p<0.01), and mean warfarin dose increased (by 8.3 %, p<0.01) in the low VK-group, only. Conclusion Centrum Plus® Supplements result in subtherapeutics INRs in patients with low VK levels. Anticoagulated patients should refrain from the unsupervised use of MV. Clinical Pharmacology & Therapeutics (2004) 75, P27–P27; doi: 10.1016/j.clpt.2003.11.100
Daniel Kurnik - One of the best experts on this subject based on the ideXlab platform.
-
Over-the-counter vitamin K1-containing Multivitamin Supplements disrupt warfarin anticoagulation in vitamin K1-depleted patients
Thrombosis and Haemostasis, 2020Co-Authors: Daniel Kurnik, Ronen Loebstein, Shlomo Almog, Hadas Rabinovitz, Naomi Austerweil, Hillel HalkinAbstract:SummaryMost Multivitamin Supplements contain far less vitamin K1 than thought to affect warfarin anticoagulation. Having described 3 patients with Multivitamin-warfarin interactions, we hypothesized that vitamin K1–depleted patients are sensitive to even small increments. Therefore, we compared the effect of a vitamin K1-containing Multivitamin on warfarin anticoagulation between patients with low versus normal vitamin K1 status. We screened 102 warfarin-treated patients and recruited nine with “low” (< 1.5 mcg/L, 10th percentile) (group 1) and 7 with “normal” (>4.5 mcg/L, median) (group 2) total vitamin K1 plasma levels (vitamin K1 + vitamin K1 2,3-epoxide). Patients received one Multivitamin tablet containing 25 mcg of vitamin K1 daily, for 4 weeks (period 1). A predefined algorithm was used to adjust warfarin doses if the INR was outside the therapeutic range. Patients requiring warfarin increments were then switched to 4 weeks of a vitamin K1-free Multivitamin supplement (period 2). During period 1, subtherapeutic INRs occurred in 9/9 and 1/7 patients in group 1 and 2, respectively (p <0.001). In group 1, INR decreased by a median of 0.51 (p <0.01), and warfarin dose had to be raised by 5.3% (p <0.01), whereas INR and warfarin dose did not change significantly in group 2. During period 2 (7 patients), there were trends towards decreased total vitamin K1 and rising INRs associated with significantly lower warfarin doses. We conclude that vitamin K1-containing Multivitamins reduce INR in patients with low vitamin K1 status. Our study suggests that vitamin Kdepleted patients are sensitive to even small changes in vitamin K1 intake.
-
Multivitamin Supplements may affect warfarin anticoagulation in susceptible patients.
Annals of Pharmacotherapy, 2020Co-Authors: Daniel Kurnik, Aharon Lubetsky, Ronen Loebstein, Shlomo Almog, Hillel HalkinAbstract:OBJECTIVE:To report an interaction of a Multivitamin preparation containing small amounts of vitamin K1 (25 μg) with warfarin in a case series and to assess the prevalence of vitamin K1 deficiency in ambulatory anticoagulated patients.CASE SUMMARIES:We describe 3 patients whose anticoagulation was stabilized with warfarin in whom initiation or cessation of a self-prescribed Multivitamin supplement delivering 25 μg of vitamin K1 daily was associated with an otherwise unexplained significant fall or rise in international normalized ratio (INR), respectively, with major thrombosis or hemorrhage in 2. This interaction was rated probable on the Naranjo probability scale. Suspecting vitamin K1 deficiency as an explanation for this oversensitivity, we assessed the prevalence of vitamin K1 deficiency in our clinic by determining plasma vitamin K1 levels in 179 stable consecutive patients, finding very low levels (
-
over the counter vitamin k1 containing Multivitamin Supplements disrupt warfarin anticoagulation in vitamin k1 depleted patients a prospective controlled trial
Thrombosis and Haemostasis, 2004Co-Authors: Daniel Kurnik, Ronen Loebstein, Hillel Halkin, Hadas Rabinovitz, Naomi Austerweil, Shlomo AlmogAbstract:: Most Multivitamin Supplements contain far less vitamin K(1) than thought to affect warfarin anticoagulation. Having described 3 patients with Multivitamin-warfarin interactions, we hypothesized that vitamin K(1)-depleted patients are sensitive to even small increments. Therefore, we compared the effect of a vitamin K(1)-containing Multivitamin on warfarin anticoagulation between patients with low versus normal vitamin K(1) status. We screened 102 warfarin-treated patients and recruited nine with "low" ( 4.5 mcg/L, median) (group 2) total vitamin K(1) plasma levels (vitamin K(1) + vitamin K(1) 2,3-epoxide). Patients received one Multivitamin tablet containing 25 mcg of vitamin K(1) daily, for 4 weeks (period 1). A predefined algorithm was used to adjust warfarin doses if the INR was outside the therapeutic range. Patients requiring warfarin increments were then switched to 4 weeks of a vitamin K(1)-free Multivitamin supplement (period 2). During period 1, subtherapeutic INRs occurred in 9/9 and 1/7 patients in group 1 and 2, respectively (p <0.001). In group 1, INR decreased by a median of 0.51 (p <0.01), and warfarin dose had to be raised by 5.3% (p <0.01), whereas INR and warfarin dose did not change significantly in group 2. During period 2 (7 patients), there were trends towards decreased total vitamin K(1) and rising INRs associated with significantly lower warfarin doses. We conclude that vitamin K(1)-containing Multivitamins reduce INR in patients with low vitamin K(1) status. Our study suggests that vitamin K-depleted patients are sensitive to even small changes in vitamin K(1) intake.
-
Over-the-counter vitamin K1-containing Multivitamin Supplements disrupt warfarin anticoagulation in vitamin K1-depleted patients A prospective, controlled trial
Thrombosis and Haemostasis, 2004Co-Authors: Daniel Kurnik, Ronen Loebstein, Hillel Halkin, Hadas Rabinovitz, Naomi Austerweil, Shlomo AlmogAbstract:Most Multivitamin Supplements contain far less vitamin K 1 than thought to affect warfarin anticoagulation. Having described 3 patients with Multivitamin-warfarin interactions, we hypothesized that vitamin K 1 -depleted patients are sensitive to even small increments. Therefore, we compared the effect of a vitamin K 1 -containing Multivitamin on warfarin anticoagulation between patients with low versus normal vitamin K, status.We screened 102 warfarin-treated patients and recruited nine with low ( 4.5 mcg/L, median) (group 2) total vitamin K 1 plasma levels (vitamin K 1 + vitamin K 1 2,3-epoxide). Patients received one Multivitamin tablet containing 25 mcg of vitamin K 1 daily, for 4 weeks (period I). A predefined algorithm was used to adjust warfarin doses if the INR was outside the therapeutic range. Patients requiring warfarin increments were then switched to 4 weeks of a vitamin K 1 -free Multivitamin supplement (period 2). During period I, subtherapeutic INRs occurred in 9/9 and 1/7 patients in group I and 2, respectively (p
-
over the counter vitamin k1 containing Multivitamin Supplements disrupt oral anticoagulation in susceptible patients a prospective trial
Clinical Pharmacology & Therapeutics, 2004Co-Authors: Daniel Kurnik, Ronen Loebstein, Shlomo Almog, Hadas Rabinovitz, Naomi Austerweil, Hillel HalkinAbstract:Background Most over-the counter Multivitamin Supplements (MV) contain far less vitamin K1 (VK) than amounts considered to affect oral anticoagulation. We have described 3 cases in whom a MV containing 25 μg VK lowered INR with severe clinical complications, suggesting that patients with low VK plasma levels are sensitive to even small VK Supplements. Aim To determine whether a MV (Centrum Plus®, 25 μg VK) affects warfarin anticoagulation, depending on baseline plasma VK. Methods Distribution of total plasma VK levels (vitamin K1 + K1-epoxide) was determined in 100 stable ambulatory patients at therapeutic INRs. 9 patients with “low” ( 4.5 ng/ml, median) levels received 1 daily tablet of Centrum Plus® for 4 weeks, with twice weekly INR control. Outcomes were: (1) need for warfarin dose change in response to subtherapeutic INR (<2.0 or <2.5 by target INR) (2) mean daily warfarin dose and mean INR on MV compared with baseline. Results In patients with low vs. normal VK, respectively, dose increases were required in 9/9 and 1/7 (p 10%, at any visit during the study period, was 5.2 (95% CI, 3.1–8.2). Mean INR decreased (by 0.45, p<0.01), and mean warfarin dose increased (by 8.3 %, p<0.01) in the low VK-group, only. Conclusion Centrum Plus® Supplements result in subtherapeutics INRs in patients with low VK levels. Anticoagulated patients should refrain from the unsupervised use of MV. Clinical Pharmacology & Therapeutics (2004) 75, P27–P27; doi: 10.1016/j.clpt.2003.11.100
