title: Hyperhomocysteinemia and B-vitamin status after discontinuation of oral anticoagulation therapy in patients with a history of venous thromboembolism.
abstract: Although hyperhomocysteinemia is an established risk factor for venous thromboembolism there is no consensus for routine determination of circulating homocysteine in the UK, either at the beginning or end of oral anticoagulation therapy. The purpose of this study was to evaluate the prevalence of hyperhomocysteinemia and its relationship to folate and vitamin B12 status in subjects with venous thromboembolism 4 weeks after discontinuation of warfarin therapy. In 78 consecutively recruited patients, plasma homocysteine was significantly higher (p < 0.001) and red cell folate significantly lower (p = 0.03) than in controls. Plasma vitamin B12 was similar in both groups. Strikingly, 38.5% of patients had hyperhomocysteinemia (> 15 micromol/l). Retrospective analysis revealed a significant positive association between plasma total homocysteine and duration of warfarin therapy (p < 0.001) but a negative, though non-significant (p = 0.06), trend with warfarin dose. The results do not suggest any direct interaction between warfarin and plasma homocysteine but raise the possibility of reduced intake of a common food source of folate and vitamin K. One possibility is the shortage of green-leafy vegetables since patients are often advised to limit their intake of this major source of vitamin K. On the basis of this study we suggest that homocysteine screening should be carried out at the time that patients begin warfarin therapy.
authors.affiliation: The Haemophilia Reference Centre, Centre For Thrombosis & Haemostasis, St. Thomas' Hospital, London, UK. agata.malefora@gstt.sthames.nhs.uk
authors.forename: Agata
authors.initials: A
authors.lastname: Sobczyńska-Malefora
authors.forename: Dominic J
authors.initials: DJ
authors.lastname: Harrington
authors.forename: Savita
authors.initials: S
authors.lastname: Rangarajan
authors.forename: Jo-Anne
authors.initials: JA
authors.lastname: Kovacs
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Shearer
authors.forename: Geoffrey F
authors.initials: GF
authors.lastname: Savidge
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005492:Folic Acid / Q000097:blood; D005838:Genotype; D006710:Homocysteine / Q000097:blood; D006801:Humans; D020138:Hyperhomocysteinemia / Q000097:blood* / Q000139:chemically induced / Q000150:complications; D008297:Male; D042965:Methylenetetrahydrofolate Reductase (NADPH2) / Q000235:genetics; D008875:Middle Aged; D012189:Retrospective Studies; D013375:Substance Withdrawal Syndrome; D013923:Thromboembolism / Q000097:blood* / Q000188:drug therapy / Q000209:etiology; D014805:Vitamin B 12 / Q000097:blood*; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D006710:Homocysteine; D014859:Warfarin; D005492:Folic Acid; D042965:Methylenetetrahydrofolate Reductase (NADPH2); D014805:Vitamin B 12