Drug General Information (ID: DDIM9ON73Y)
Drug Name			Vitamin E		Drug Info		Antithrombin Alfa		Drug Info
Drug Type		Small molecule				Protein/peptide
Therapeutic Class		Vitamins				Recombinant Antithrombin

Mechanism of Vitamin E-Antithrombin Alfa Interaction (Severity Level: Moderate)
Increased risk of bleeding Click to Show/Hide Mechanism Graph
Drug Name		Vitamin E				Antithrombin Alfa
Mechanism		Risk of bleeding Anticoagulant effects				Risk of bleeding Anticoagulant
Key Mechanism Factor 1
		Factor Name		Bleeding
		Factor Description		Patients may be at risk for bleeding when the outcome of a disease or disease treatment confounds the standard mechanisms for maintaining hemostasis. Signs or symptoms of abnormal bleeding include: bleeding that takes a long time to stop (including nosebleeds, bleeding gums, bleeding from cuts and abrasions, and menstrual bleeding); severe unexplained bruising, or bruising that becomes larger; blood in the urine or stool, etc.
Mechanism Description		Increased risk of bleeding by the combination of Vitamin E and Antithrombin Alfa

Recommended Action
Management		Patients should consult a healthcare provider before taking any nutritional supplements like vitamin E. Close clinical and laboratory observation for hematologic complications may be appropriate when vitamin E supplementation at dosages greater than 400 units/day is initiated in patients stabilized on anticoagulant or antiplatelet therapy. The dose of the anticoagulant or antiplatelet drug may require adjustment during and after treatment with vitamin E. Patients should be advised to promptly report any signs of bleeding to their physician, including pain, swelling, headache, dizziness, weakness, prolonged bleeding from cuts, increased menstrual flow, vaginal bleeding, nosebleeds, bleeding of gums from brushing, unusual bleeding or bruising, red or brown urine, or red or black stools.

References
1	Gonzalez-Correa JA, Arrebola MM, Guerrero A, et al. "Influence of vitamin E on the antiplatelet effect of acetylsalicylic acid in human blood." Platelets 16(3-4) (2005): 171-9. [PMID: 16011961]
2	Helson L "The effect of intravenous vitamin E and menadiol sodium diphosphate on vitamin K dependent clotting factors." Thromb Res 35 (1984): 11-8. [PMID: 6474408]
3	Kakishita E, Suehiro A, Oura Y, Nagai K "Inhibitory effect of vitamin E (alpha-tocopherol) on spontaneous platelet aggregation in whole blood." Thromb Res 60 (1990): 489-99. [PMID: 2082481]