Abstract
The efficacy and safety of vitamin K antagonists (VKAs) as oral anticoagulants (OACs) depend on the quality of anticoagulation control, as reflected by the mean time in therapeutic range (TTR). Several factors may be involved in poor TTR such as comorbidities, high inter-individual variability, interacting drugs, and non-adherence. Recent studies suggest that gut microbiota (GM) plays an important role in the pathogenesis of cardiovascular diseases, but the effect of the GM on anticoagulation control with VKAs is unknown. In the present review article, we propose different mechanisms by which the GM could have an impact on the quality of anticoagulation control in patients taking VKA therapy. We suggest that the potential effects of GM may be mediated first, by an indirect effect of metabolites produced by GM in the availability of VKAs drugs; second, by an effect of vitamin K-producing bacteria; and finally, by the structural modification of the molecules of VKAs. Future research will help confirm these hypotheses and may suggest profiles of bacterial signatures or microbial metabolites, to be used as biomarkers to predict the quality of anticoagulation. This could lead to the design of intervention strategies modulating gut microbiota, for example, by using probiotics.
Highlights
In anticoagulated patients with vitamin K antagonists (VKAs), the quality of anticoagulation control is central to avoiding thromboembolic and bleeding complications
In the search of potential factors affecting the quality of VKAs, gut microbiota, which have shown to play an important role in several cardiovascular diseases, could have an impact on the response to VKA
This could be the result of an indirect effect of metabolites produced by gut microbiota in the availability of VKAs drugs, an effect of vitamin K-producing bacteria, or by the structural modification of the molecule of VKAs drug
Summary
Aside from AF patients, there is a wide range of patients for whom VKAs are the recommended OAC therapy, for example, AF patients with rheumatic mitral stenosis and the presence of mechanical valvular prostheses [3,5]. An important proportion of VTE patients who could be potential users of DOACs are taking VKAs. In patients who are prescribed VKAs, the quality of anticoagulation control is central to prevent bleeding and thromboembolic events [11]. The aim of the present review is to summarize published data on the potential impact of the gut microbiota on the quality of anticoagulation of patients receiving VKA therapy, and to suggest different hypotheses that could associate intestinal bacterial with VKA
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