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Potentiation of Vitamin K Antagonists by High-Dose Intravenous Methylprednisolone

Nathalie Costedoat-Chalumeau, MD; Zahir Amoura, MD; Guy Aymard, PhD; Odile Sevin, MD; Bertrand Wechsler, MD; Patrice Cacoub, MD; Le Thi Huong Du, MD; Bertrand Diquet, MD; Annick Ankri, MD; and Jean-Charles Piette, MD
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From Groupe Hospitalier Universitaire Pitié-Salpêtrière, Paris, France.

Requests for Single Reprints: Zahir Amoura, Service de Médecine Interne, Hôpital Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75013 Paris, France; e-mail, zahir.amoura@psl.ap-hop-paris.fr.

Requests To Purchase Bulk Reprints (minimum, 100 copies): the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints@mail.acponline.org.

Current Author Addresses: Drs. Costedoat-Chalumeau, Amoura, Wechsler, Cacoub, Huong Du, and Piette: Service de Médecine Interne, Groupe Hospitalier Universitaire Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75013 Paris, France.

Drs. Aymard and Diquet: Service de Pharmacologie, Groupe Hospitalier Universitaire Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75013 Paris, France.

Drs. Sevin and Ankri: Laboratoire d'Hémostase, Groupe Hospitalier Universitaire Pitié-Salpêtrière, 47-83 boulevard de l'Hôpital, 75013 Paris, France.

Author Contributions: Conception and design: N. Costedoat-Chalumeau, Z. Amoura, G. Aymard, A. Ankri, J.C. Piette.

Analysis and interpretation of the data: N. Costedoat-Chalumeau, Z. Amoura, G. Aymard, J.C. Piette.

Drafting of the article: N. Costedoat-Chalumeau, Z. Amoura.

Critical revision of the article for important intellectual content: Z. Amoura, J.C. Piette.

Final approval of the article: Z. Amoura, J.C. Piette.

Provision of study materials or patients: Z. Amoura, G. Aymard, O. Sevin, B. Wechsler, P. Cacoub, L.T. Huong Du, B. Diquet, A. Ankri, J.C. Piette.

Administrative, technical, or logistic support: Z. Amoura.

Collection and assembly of data: Z. Amoura.

Ann Intern Med. 2000;132(8):631-635. doi:10.7326/0003-4819-132-8-200004180-00005
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Background: Oral anticoagulants and pulse high-dose intravenous methylprednisolone are often administered concomitantly, but no data on potential interactions are available.

Objective: To assess possible potentiation of oral anticoagulation by high-dose intravenous methylprednisolone.

Design: Prospective cohort study.

Setting: University hospital in Paris, France.

Patients: 10 consecutive patients concomitantly receiving methylprednisolone and oral anticoagulants (fluindione and acenocoumarol) and 5 consecutive controls receiving methylprednisolone alone.

Measurements: Serial determinations of the international normalized ratio (INR) and clotting factors during administration of pulse methylprednisolone. The total plasma fluindione concentration was determined in 3 patients.

Results: The mean INR was 2.75 (range, 2.02 to 3.81) at baseline and increased to 8.04 (range, 5.32 to 20.0) after methylprednisolone administration. Plasma fluindione concentrations and the INR increased after methylprednisolone administration. Methylprednisolone alone did not increase prothrombin time.

Conclusions: The action of oral anticoagulants is potentiated by intravenous high-dose methylprednisolone. The INR should be monitored daily during concomitant administration of these medications.


Grahic Jump Location
Figure 1.
Potentiation of vitamin K antagonists by intravenous high-dose methylprednisolone in patients 1 through 10.INR

Arrows indicate administration of pulse intravenous high-dose methylprednisolone; bars indicate total fluindione concentration; solid lines indicate the international normalized ratio ( ).

Grahic Jump Location
Grahic Jump Location
Figure 2.
Lack of effect of intravenous high-dose methylprednisolone alone on prothrombin time in five controls.

Arrows indicate administration of pulse intravenous high-dose methylprednisolone.

Grahic Jump Location




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Summary for Patients

High Doses of a Corticosteroid Drug Interfere with Anticoagulant Medicines

The summary below is from the full report titled “Potentiation of Vitamin K Antagonists by High-Dose Intravenous Methylprednisolone”. It is in the 18 April 2000 issue of Annals of Internal Medicine (volume 132, pages 631-635). The authors are N. Costedoat-Chalumeau, Z. Amoura, G. Aymard, O. Sevin, B. Wechsler, P. Cacoub, L.T.H. Du, B. Diquet, A. Ankri, and J.-C. Piette.


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