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Bern M. Observations on Possible Effects of Daily Vitamin K Replacement, Especially Upon Warfarin Therapy. JPEN J Parenter Enteral Nutr 2017; 28:388-98. [PMID: 15568285 DOI: 10.1177/0148607104028006388] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Daily parenteral vitamin K supplement is now recommended by the U.S. Food and Drug Administration (FDA) for patients receiving IV hyperalimentation. This is considered as preferable to the previous recommendations of weekly parenteral or oral supplement, or as in some cases no supplement at all. Supplemental vitamin K1 will ensure adequate supplies for hepatic saturation and thus the production of clotting factors II, VII, IX, and X, plus the anticoagulants protein C, protein S, and protein Z. But this is not the entire story. This recommended supplement will affect other physiologic systems that also use vitamin K-dependent gamma-carboxylation. Vitamin K is not 1 molecule but rather 2 natural substances, vitamin K1 and K2, and the synthetic K3's. It is not understood, what, if any, effect may occur because of the saturation or competition from the vitamin K1 upon the functioning of vitamins K2 and the derivatives of K3 in vivo upon bone mineralization, cell growth, and blood vessel health, all known to be influenced by the vitamins K. There are probably other physiologic systems yet to be studied relative to vitamins K and gamma-carboxylation. This review also considers the available research upon warfarin when given to patients receiving hyperalimentation and what effects the vitamin K supplements may have. Because studies to date have not controlled for vitamin K intake, consideration is given to whether one should expect any change in previously reported outcomes when using low-dose warfarin for prophylaxis against central vein thrombosis. Also considered are possible positive or negative effects that chronic warfarin therapy may have upon the other vitamin K-dependent systems under discussion. This review offers a platform for further discussion and derived clinical research provoked by this new FDA recommendation.
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Affiliation(s)
- Murray Bern
- Cancer Center of Boston, New England Baptist Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Demir HD, Yalçındağ FN, Öztürk A, Akar N. Intron F G79A Polymorphism of the Protein Z Gene in Turkish Behçet Patients. Curr Eye Res 2012; 37:630-2. [DOI: 10.3109/02713683.2012.669004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
PURPOSE OF REVIEW To alert physician to timely recognition and current treatment of recurrent hypopyon iridocyclitis or panuveitis in ocular Behçet disease (OBD). RECENT FINDINGS Interferon-α, rituximab, intravitreal triamcinolone, and biological response modifiers by tumor necrosis factor inhibitors such as infliximab and adalimumab are being used increasingly for the treatment of severe sight-threatening ocular inflammation including retinal vasculitis and cystoid macular edema (CME). SUMMARY Biological agents offer tremendous potential in the treatment of OBD. Given that OBD predominantly afflicts the younger adults in their most productive years, dermatologist, rheumatologist, internist, or general practitioners supervising patients with oculo-articulo-oromucocutaneous syndromes should be aware of systemic Behçet disease. Early recognition of ocular involvement is important and such patients should strongly be instructed to visit immediately an ophthalmologist, as uveitis management differs from extraocular involvements with high ocular morbidity from sight-threatening complications due to relapsing inflammatory attacks in the posterior segment of the eye. A single infliximab infusion should be considered for the control of acute panuveitis, whereas repeated long-term infliximab infusions were proved to be more effective in reducing the number of episodes in refractory uveoretinitis with faster regression and complete remission of CME.
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Affiliation(s)
- Cem Evereklioglu
- Department of Ophthalmology, Erciyes University Medical Faculty, Kayseri, Turkey
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The risk of occurrence of venous thrombosis: focus on protein Z. Thromb Res 2011; 128:508-15. [PMID: 21885093 DOI: 10.1016/j.thromres.2011.08.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 07/14/2011] [Accepted: 08/03/2011] [Indexed: 11/20/2022]
Abstract
Protein Z (PZ) is a vitamin K-dependent factor identified in human plasma in 1984 characterized by an homology with other vitamin K-dependent factors. PZ acts as the cofactor of the PZ dependent inhibitor (ZPI), in the inhibition of activated factor X bound on phospholipid surface. In humans, PZ is characterized by an unusual wide distribution in plasma partly explained by a genetic control. Several PZ gene polymorphisms influencing plasma concentration have been described. In mice, the disruption of PZ gene is asymptomatic, but in association with homozygous FV Leiden produced a severe prothrombotic phenotype. This review analyzes the results obtained from different studies so far published in order to understand whether PZ deficiency could be considered as a risk factor for venous thrombosis. The roles of PZ plasma level and PZ gene polymorphisms remain debated with conflicting results. Many of these studies reported low PZ levels in association with an increased risk of venous thrombosis. On the other side, some studies did not observe an association between low levels of PZ and thrombotic events. A relationship between PZ deficiency and pregnancy complications was also described but not confirmed by all studies. These discrepancies can be explained by the heterogeneity of populations chosen as control, by the PZ interindividual variability and by the small size of the cohorts in mainly retrospective studies. Large prospective studies remain to be done to investigate its possible role in thrombosis.
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Kaygusuz I, Firatli-Tuglular T, Toptas T, Ugurel V, Demir M. Low levels of protein Z are associated with HELLP syndrome and its severity. Clin Appl Thromb Hemost 2010; 17:214-9. [PMID: 20460354 DOI: 10.1177/1076029609357738] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Protein Z (PZ) was found to be associated with pregnancy complications. There are no data implying an association between hemolysis (H), elevated liver enzymes (EL), and low platelet counts (LP) (HELLP) syndrome and changes in plasma levels of PZ. The aim of this study is to investigate whether HELLP syndrome is associated with plasma concentrations of PZ. Protein Z levels in 29 women with HELLP syndrome were compared with 29 healthy, nulliparous and 25 normal pregnant women. The median PZ levels in patients with HELLP syndrome were found to be significantly lower than those of pregnant women. No significant difference was found between HELLP and healthy groups. Protein Z levels correlated with platelet counts, lactate dehydrogenase (LDH), and aspartate aminotransferase (AST) levels in patients with HELLP syndrome. Median PZ level was higher in partial HELLP than in complete HELLP. We calculated 1330 ng/mL as a cutoff value for PZ level to discriminate HELLP syndrome from normal pregnancy. Low PZ levels are associated with the pathobiology of HELLP syndrome.
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Affiliation(s)
- Isik Kaygusuz
- Division of Hematology, Department of Internal Medicine, Marmara University Hospital, Istanbul, Turkey.
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Le Cam-Duchez V, Barbay V, Soria C, Borg JY. [Protein Z, polymorphisms in the protein Z gene and thrombosis]. Rev Med Interne 2010; 31:551-7. [PMID: 20416992 DOI: 10.1016/j.revmed.2009.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2009] [Revised: 04/16/2009] [Accepted: 04/22/2009] [Indexed: 11/28/2022]
Abstract
Protein Z (PZ) is a vitamin K dependent protein acting as the cofactor of the protein Z dependent inhibitor (ZPI), in the inhibition of activated factor X bound on the phospholipids. Normal plasma protein Z concentrations have wide variations among individuals, partly explained by a genetic control. Several protein Z gene polymorphisms influence plasma concentration, separately and in combination. The role of PZ in blood coagulation regulation has been demonstrated in vitro. The responsibility of low PZ level in the occurrence of thrombosis has been questioned. However, the roles of PZ plasma level and PZ gene polymorphisms remain debated with conflicting results in arterial, venous, or placental thrombosis. These discrepancies can be explained by the heterogeneity of populations chosen as control, by the PZ interindividual variability, by the small size of the cohorts in mainly retrospective studies and perhaps by the lack of real important influence of this protein on coagulation. PZ measurement is not actually considered as a biological marker of thrombophilia. Large prospective studies remain to be done to investigate its possible role in thrombosis.
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Affiliation(s)
- V Le Cam-Duchez
- Unité d'hémostase vasculaire, hématologie biologique, hôpital Charles-Nicolle, CHU de Rouen, EA3829, groupe de recherche MERCI, institut hospitalo-universitaire de recherche biomédicale, université de Rouen, 22, boulevard Gambetta, 76183 Rouen cedex, France.
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La Regina M, Gasparyan AY, Orlandini F, Prisco D. Behçet's Disease as a Model of Venous Thrombosis. Open Cardiovasc Med J 2010; 4:71-7. [PMID: 20360979 PMCID: PMC2847254 DOI: 10.2174/1874192401004020071] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Revised: 11/23/2009] [Accepted: 12/12/2009] [Indexed: 01/11/2023] Open
Abstract
Behçet's disease (BD) is a chronic inflammatory disease of unknown aetiology characterized by recurrent oral, genital aphthous ulcerations, uveitis, skin lesions and other multisystem affections associated with vasculitis. Different types of vessels, predominantly veins, can be affected in BD. The frequency of vascular lesions in BD, such as superficial and deep venous thromboses, arterial aneurysms and occlusions, ranges between 7-29%. In this review, various factors of thrombogenesis in BD, particularly pro- and antithrombotic endothelial and non-endothelial factors, factors of coagulation, platelet activation and rheological changes are presented and discussed from positions of Virchow's triad of venous thrombosis. Despite advances in understanding of thrombogenesis in BD, still many issues of diagnosis and targeted preventive and therapeutic measures remain unresolved. Further studies are needed to clarify the pathobiology of BD-related thrombosis and to provide the clinicians with recommendations over the utility, safety and effectiveness of the antithrombotic therapy in BD.
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Affiliation(s)
- Micaela La Regina
- Department of Internal Medicine, Periodic Fevers Research Centre, Catholic University, Rome, Italy
| | | | | | - Domenico Prisco
- Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy
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Regina ML, Gasparyan AY, Orlandini F, Prisco D. Behçet’s Disease as a Model of Venous Thrombosis. Open Cardiovasc Med J 2010. [DOI: 10.2174/1874192401004010071] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Behçet’s disease (BD) is a chronic inflammatory disease of unknown aetiology characterized by recurrent oral, genital aphthous ulcerations, uveitis, skin lesions and other multisystem affections associated with vasculitis. Different types of vessels, predominantly veins, can be affected in BD. The frequency of vascular lesions in BD, such as superficial and deep venous thromboses, arterial aneurysms and occlusions, ranges between 7-29%.
In this review, various factors of thrombogenesis in BD, particularly pro- and antithrombotic endothelial and non-endothelial factors, factors of coagulation, platelet activation and rheological changes are presented and discussed from positions of Virchow’s triad of venous thrombosis.
Despite advances in understanding of thrombogenesis in BD, still many issues of diagnosis and targeted preventive and therapeutic measures remain unresolved. Further studies are needed to clarify the pathobiology of BD-related thrombosis and to provide the clinicians with recommendations over the utility, safety and effectiveness of the antithrombotic therapy in BD.
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Calgüneri M, Aydemir K, Oztürk MA, Haznedaroğlu IC, Kiraz S, Ertenli I. Myocardial infarction and deep venous thrombosis in a young patient with Behçet disease. Clin Appl Thromb Hemost 2006; 12:105-9. [PMID: 16444444 DOI: 10.1177/107602960601200118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Behçet disease (BD) is a chronic relapsing systemic vasculitic disorder affecting the arteries, veins, and vessels of any size. Vascular lesions in BD usually represent an occlusive nature suggesting a hypercoagulable/ prothrombotic state. Coronary arteries are rarely involved in BD. In this report, a 27-year-old male patient in whom myocardial infarction developed secondary to coronary arterial thrombosis together with deep venous thrombosis was presented. This is a review of the pathologic hemostasis and the prothrombotic state of BD.
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Affiliation(s)
- Meral Calgüneri
- Rheumatology, Hacettepe University School of Medicine, Ankara, Turkey
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Magy N. [Protein Z: a new factor of thrombophilia?]. Rev Med Interne 2005; 26:891-3. [PMID: 16137798 DOI: 10.1016/j.revmed.2005.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2005] [Accepted: 07/04/2005] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Sometimes, in front of a clinical setting of thrombophilia, the biological findings are helpless. Therefore we suggest to test a protein Z deficiency. EXEGESIS Protein Z is a vitamin-K dependent protein forming a complex with the Z protein-dependent protease inhibitor for inhibiting the activated factor X; so protein Z acts as a "natural low molecular weight heparin". The prothrombotic phenotype associated with protein Z deficiency includes early fetal losses (before the 20th week of gestation), early and relapsing venous thrombosis in patients with factor V Leiden mutation and somehow ischaemic stroke in young people. CONCLUSION The protein Z deficiency seems to be associated with a particular prothrombotic phenotype including early fetal losses as well as early and relapsing venous thromboses in patients carrying the factor V Leiden mutation. It is unclear whether or not it plays a role as a thrombophilic factor especially in the arterial vascular field.
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Affiliation(s)
- N Magy
- Service de médecine interne et immunologie clinique, CHU Jean-Minjoz, 2, boulevard Fleming, 25000 Besançon, France.
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