TY - JOUR
T1 - Gut Microbiota and the Quality of Oral Anticoagulation in Vitamin K Antagonists Users
T2 - A Review of Potential Implications
AU - Camelo-Castillo, Anny
AU - Rivera-Caravaca, José Miguel
AU - Orenes-Piñero, Esteban
AU - Ramírez-Macías, Inmaculada
AU - Roldán, Vanessa
AU - Lip, Gregory Y H
AU - Marín, Francisco
PY - 2021/2/11
Y1 - 2021/2/11
N2 - 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.
AB - 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.
KW - Gut microbiota
KW - Microbial metabolites
KW - Oral anticoagulants
KW - Trimethylamine n-oxide
KW - Vitamin k
UR - http://www.scopus.com/inward/record.url?scp=85114064757&partnerID=8YFLogxK
U2 - 10.3390/jcm10040715
DO - 10.3390/jcm10040715
M3 - Review article
C2 - 33670220
SN - 2077-0383
VL - 10
SP - 1
EP - 16
JO - Journal of Clinical Medicine
JF - Journal of Clinical Medicine
IS - 4
M1 - 715
ER -