Vitamine K

CREATIF, Centre de référence et d’éducation des antihrombotiques d’Ile-de-France, Service d’angio-hématologie, Hôpital Lariboisière, 2 rue A. Paré, 75 475 Paris cedex 10

^* creatif.lrb@lrb.aphp.fr

Abstract

Subclasses of vitamin K, their origins, their differential characteristics of absorption and metabolism, their relative effects on gammacarboxylation of various proteins implicated in hemostasis andcoagulation, in bone calcification are not well known even by experts in these fields. These misunderstandings explain errors in recommendations for public and for patients. This review will not expose again the fundamentals on vitamins K as presented in the paper by Marc Guillaumont published in 2000 in this same journal. This 2011 review will try to update our actual knowledge and most of all will insist on their practical implications especially on the management of oral anticoagulant treatments since until recently vitamin K antagonist was the only available type of such a treatment. Several examples illustrate the need for a better understanding of this subject. The fear that diet vitamin K could deregulate the equilibrium of oral vitamin K antagonist treatment leads to recommend a quite total suppression of vitamin K containing components in the diet of anticoagulated patients. This leads to an opposite effect: a high sensitivity to vitamin K and to disequilibrium of the anticoagulant treatment while a comprehensivemoderate and regular diet intake of vitamin K first facilitates the food choice of the patients but also helps to stabilise the treatment of chronically anticoagulated patients. Vitamin K plays a role in bone calcification and in osteoporosis prevention. Until recently the food supplementation with vitamin K in view of preventing osteoporosis in general population was strongly limited due to fear to affect the treatment equilibrium in anticoagulated patients. While an understanding that the effects of moderate supplementation in vitamin K has no or limited effect on anticoagulation and on the long run could at the opposite help to stabilize the daily level of anticoagulation in patients chronically treated with vitamin K.