Miracon Science

Vitamin K antagonists and heparins

Mechanism of interaction

Mechanism of interaction
Vitamin K There is a direct antagonist relationship. Vitamin K enables the carboxylation of glutamyl residues, which leads to the activation of coagulation factors and bone proteins. Vitamin K antagonists like warfarin inhibit this process.
Coenzyme Q10 In vitro, the structural relationship between coenzyme Q10 and menaquinone (vitamin K2) impairs the effect of vitamin K antagonists. Since vitamin K is involved in the synthesis and activation of various coagulation factors, coenzyme Q10 can reduce the effect of blood thinning drugs, requiring dose adjustment.
Omega-3 fatty acids Omega-3 fatty acids can regulate the metabolism of the omega-6 fatty acid, arachidonic acid, with long-term use, thereby reducing platelet aggregation and the formation of TXA2. In addition, plasma factor VII and fibrinogen levels are lowered.
Calcium/Vitamin D Long-term administration (15000 IU of unfractionated heparin over three months ) increases the risk of osteoporosis. Osteoblast proliferation decreases and parathyroid hormone levels and bone resorption rates increase.

Consequences and possible symptoms of the interaction

Negative consequences of the interaction Possible symptoms
Vitamin K Decrease in vitamin K levels
  • High bleeding tendency,
  • Disturbance of bone structure, decrease in bone density, decrease in osteocalcin level, osteoarthritis
  • Increased Ca excretion favors arteriosclerosis
  • Increased risk of vertebral and rib fractures with long-term use (>12 months)
Coenzyme Q10 Decrease of the anticoagulative effect
  • Decrease of drug effectiveness at very high doses in vitro
Calcium/Vitamin D Decrease in levels
  • Spontaneous fracture risk increases
Positive consequences of the interaction Possible symptoms
Omega-3 fatty acids Increases the anticoagulative effect
  • Reduction of the need for warfarin or phenprocoumon

Recommended Supplementation

Medical substance Recommended supplementation Dosage
Vitamin K antagonists Omega-3 fatty acids 1000 mg/d p.o.
Vitamin K2 100 µg/d p.o.
Heparin Calcium 500-1000 mg/d p.o.
Vitamin D 2000-4000 I.U./d p.o.

Special instructions for use

Instructions for use
Omega-3 fatty acids An exact monitoring of the INR values is advisable.

References

References

Buckley MS et al. Fish oil interaction with warfarin. Ann Pharmacother. 2004 Jan;38(1):50-2.
Gröber U. Mikronährstoffe. Metabolic Tuning – Prävention – Therapie. 3. Auflage, 2011
Gröber U. Arzneimittel und Mikronährstoffe. Medikationsorientierte Supplementierung.
3. Akt. und erw. Auflage, 2014
Mazziotti G et al. Drug-induced osteoporosis: mechanisms and clinical implications. Am J Med. 2010 Oct;123(10):877-84. doi: 10.1016/j.amjmed.2010.02.028.
Mutoh S et al. Characterization of heparin-induced osteopenia in rats. Endocrinology. 1993 Dec;133(6):2743-8.
Stargrove Mitchell Bebel, Treasure Jonathan, McKee Dwight L.: Herb, Nutrient, and Drug Interactions: Clinical Implications and Therapeutic Strategies. 2008
Vanschoonbeek K et al. Variable hypocoagulant effect of fish oil intake in humans: modulation of fibrinogen level and thrombin generation. Arterioscler Thromb Vasc Biol. 2004 Sep;24(9):1734-40. Epub 2004 Jun 24.
Zhou Q et al. Effect of coenzyme Q10 on warfarin hydroxylation in rat and human liver microsomes. Curr Drug Metab. 2005 Apr;6(2):67-81.
Zhou S, Chan E. Effect of ubidecarenone on warfarin anticoagulation and pharmacokinetics of warfarin enantiomers in rats. Drug Metabol Drug Interact. 2001;18(2):99-122.

 

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