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Vitamin E-Induced Coagulopathy in a Young Patient

Core Concepts
High-dose vitamin E can induce coagulopathy even at marginally increased levels.
Abstract and Introduction High-dose vitamin E can inhibit vitamin K-derived coagulation factor synthesis. Case study of a 31-year-old man with vitamin E-induced coagulopathy. Diagnosis involved deficiency of multiple coagulation factors due to acquired vitamin K deficiency. Treatment included pantoprazole, vitamin K supplementation, and fresh frozen plasma transfusions. Patient recovered with complete resolution of symptoms. Conclusions Vitamin E can inhibit vitamin K-dependent factors causing coagulopathy. Risk increases in patients taking other drugs that raise bleeding risk. Introduction Vitamin E toxicity is rare but can occur in cases of altered absorption or excretion. High-dose vitamin E inhibits vitamin K-related enzyme activation for coagulation factor synthesis. Deficiency of factors II, VII, IX, and X can lead to bleeding. Vitamin E excess inhibits factor IX activation and platelet aggregation. Vitamin E toxicity can present with coagulopathies and general symptoms. Uncertainty exists regarding the minimum dose and duration of vitamin E intake to affect coagulation pathways.
Serum fibrinogen was slightly raised. Serum alpha-tocopherol was slightly raised. Prothrombin induced by vitamin K absence-II level was increased.
"Vitamin E-related inhibition of vitamin K-dependent factors with coagulopathy may occur even at marginally increased levels of serum vitamin E." "Vitamin E toxicity may be overlooked as the cause of coagulopathy if serum levels of vitamin E are only marginally increased."

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by Ritika Abrol at 05-26-2023
Vitamin E-induced Coagulopathy in a Young Patient

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How can healthcare providers effectively monitor and prevent vitamin E-induced coagulopathy?

Healthcare providers can effectively monitor and prevent vitamin E-induced coagulopathy by being vigilant about patients' vitamin E intake, especially in cases where patients are taking high doses of vitamin E supplements. Regular monitoring of coagulation parameters, such as prothrombin time, activated partial thromboplastin time, and bleeding time, can help in early detection of coagulopathy. Additionally, healthcare providers should be aware of the potential interactions between vitamin E and other medications that may increase the risk of bleeding. Preventive measures include educating patients about the risks of vitamin E toxicity and advising them on appropriate dosages based on individual needs. In cases where vitamin E toxicity is suspected, prompt discontinuation of vitamin E supplementation, along with vitamin K supplementation and supportive treatments, can help in reversing the coagulopathy.

What are the implications of vitamin E toxicity in patients with altered absorption or excretion?

Patients with altered absorption or excretion, such as those with lipid or hepatobiliary disorders, are at an increased risk of vitamin E toxicity. In these patients, vitamin E may accumulate in the body due to impaired excretion, leading to inhibition of vitamin K-dependent coagulation factor synthesis. This can result in coagulopathies, such as bleeding disorders, due to deficiencies in factors II, VII, IX, and X. Furthermore, vitamin E toxicity in patients with altered absorption or excretion can exacerbate existing coagulation abnormalities and increase the risk of bleeding events. Healthcare providers should be cautious when prescribing vitamin E supplements to patients with underlying conditions that may affect its metabolism and excretion.

How can the medical community raise awareness about the risks of vitamin E toxicity in coagulation pathways?

To raise awareness about the risks of vitamin E toxicity in coagulation pathways, the medical community can engage in educational initiatives targeting healthcare providers, patients, and the general public. Healthcare providers should be educated about the potential interactions between vitamin E and vitamin K-dependent coagulation factors, as well as the signs and symptoms of vitamin E-induced coagulopathy. Clinical guidelines should include recommendations on monitoring vitamin E levels and coagulation parameters in at-risk patients. Patient education materials should emphasize the importance of discussing all supplements, including vitamin E, with healthcare providers to prevent adverse effects. Public awareness campaigns can highlight the potential dangers of excessive vitamin E intake and promote safe supplement use. By increasing awareness at multiple levels, the medical community can help prevent and manage vitamin E-induced coagulopathy effectively.