Abstract
Warfarin is a vitamin K antagonist agent that inhibits clotting factors used for long-term anticoagulation. Time in therapeutic range (TTR) in patients using warfarin is one of the primary treatment effectiveness requirements. We aim to investigate the relationship between serum magnesium levels, the international normalized ratio (INR) values, and TTR values in people using warfarin for various indications. Our study is a single-center, cross-sectional, and retrospective study that included 169 patients between 18 and 70 who used warfarin for various indications. Demographic data, biochemical analysis, and coagulation parameters, including TTR calculation, were evaluated for all patients. Those with a TTR value below 60 were defined as labile INR, and those with 60 and above as stable INR group and compared. The mean INR value was higher in the labile INR group than the stable INR group (3.7 ± 2.9, 3.2 ± 0.3, respectively; p = 0.030). The Mg values are significantly lower in the labile INR group than the stable group (1.8 ± 0.2 mg/dL, 2.0 ± 0.1 mg/dL, respectively; p < 0.001). In binary multivariate logistic regression analysis, magnesium value was the most influential INR stabilization factor (p < 0.001). As a result of our study, it was concluded that magnesium levels are an influential factor in stabilizing INR. We can state that we have contributed to the literature and can be a reference for future studies.
Similar content being viewed by others
References
Di Minno A, Frigerio B, Spadarella G, Ravani A, Sansaro D, Amato M, Kitzmiller JP, Pepi M, Tremoli E, Baldassarre D (2017) Old and new oral anticoagulants: food, herbal medicines and drug interactions. Blood Rev 31(4):193–203
Akyuz O, Ardahanli I, Aslan R (2020) Relationship between chronic complications of type 2 diabetes mellitus and hypomagnesemia. J Elem 25(2):565–579
Wigle P, Hein B, Cr B (2019) Anticoagulation updated guidelines for outpatient management. Am Fam Physician 100(7):426–434
Den Besselaar V, Am CV, Tripodi A (2010) Thromboplastin standards. Biologicals 38(4):430–436
January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC Jr, Ellinor PT, Ezekowitz MD, Field ME, Furie KL, Heidenreich PA, Murray KT, Shea JB, Tracy CM (2019) AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines and the heart rhythm society in collaboration with the society of thoracic surgeons. Circulation 140:e125–e151
De Caterina R, Husted S, Wallentin L, Andreotti F, Arnesen H, Bachmann F, Baigent C, Huber K, Jespersen J, Kristensen SD, Lip GY, Morais J, Rasmussen L, Siegbahn A, Verheugt FW, Weitz J (2013) Vitamin K antagonists in heart disease: current status and perspectives (section III). Position paper of the ESC working group on thrombosis–task force on anticoagulants in heart disease. Thromb Haemost 110(6):1087–1107
De Baaij Jh, Jg H, Rj B (2015) Magnesium in man: implications for health and disease. Physiol Rev 95(1):1–46
Mussoni L, Sironi L, Tedeschi L, Am C, Colli S, Tremoli E (2001) Magnesium inhibits arterial thrombi after vascular injury in rat: in vivo impairment of coagulation. Thromb Haemost 86(5):1292–1295
Miller EMS, Sakowicz A, Leger E, Lange E, Yee LM (2021) Association between receipt of intrapartum magnesium sulfate and postpartum hemorrhage. AJP Rep 11(1):e21–e25
Abou Shady EA, Farrag HE, El-Damarawy NA, Mohammed FA, Kamel AM, Massoud AA (1991) In vitro effects of trace elements on blood clotting and platelet function. B-Zinc and magnesium. J Egypt Public Health Assoc 66(1–2):49–72
Butenas S, Lawson JH, Kalafatis M, Mann KG (1994) Cooperative interaction of divalent metal ions, substrate, and tissue factor with factor VIIa. Biochemistry 33(11):3449–3456
Van Den Besselaar AM, Van Dam W, Sturk A, Bertina RM (2001) Prothrombin time ratio is reduced by magnesium contamination in evacuated blood collection tubes. Thromb Haemost 85(4):647–650
Dehkordy ME, Tavanaei R, Younesi E, Khorasanizade S, Farsani HA, Oraee-Yazdani S (2020) Effects of perioperative magnesium sulfate infusion on intraoperative blood loss and postoperative analgesia in patients undergoing posterior lumbar spinal fusion surgery: a randomized controlled trial. Clin Neurol Neurosurg 196:105983
Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, La Meir M, Lane DA, Lebeau JP, Lettino M, Lip GYH, Pinto FJ, Thomas GN, Valgimigli M, Van Gelder IC, Van Putte BP, Watkins CL; ESC Scientific Document Group (2021) 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J (42)5:373-498.
Nieuwlaat R, Connolly BJ, Hubers LM, Cuddy SM, Eikelboom JW, Yusuf S, Connolly SJ, Investıgators A (2012) Quality of individual INR control and the risk of stroke and bleeding events in atrial fibrillation patients: a nested case control analysis of the ACTIVE W study. Thromb Res 129(6):715–719
Gajsiewıcz JM, Nuzzıo KM, Rienstra CM, Morrissey JH (2015) Tissue factor residues that modulate magnesium-dependent rate enhancements of the tissue factor/factor VIIa complex. Biochemistry 54(30):4665–4671
Palta S, Saroa R, Palta A (2014) Overview of the coagulation system. Indian J Anaesth 58(5):515–523
Sekiya F, Yoshida M, Yamashita T, Morita T (1996) Magnesium(II) is a crucial constituent of the blood coagulation cascade. Potentiation of coagulant activities of factor IX by Mg2+ ions. J Biol Chem 271(15):8541–8544
Jafari M, Di Napoli M, Lattanzi S, Mayer SA, Bachour S, Bershad EM, Damani R, Datta Yh, Divani AA (2019) Serum magnesium level and hematoma expansion in patients with intracerebral hemorrhage. J Neurol Sci 398:39–44
Mochizuki A, Kaneda H (2015) Study on the blood compatibility and biodegradation properties of magnesium alloys. Mater Sci Eng C Mater Biol Appl 47:204–210
Nelson WW, Desai S, Damaraju CV, Lu L, Fields LE, Wildgoose P, Schein JR (2015) International normalized ratio stability in warfarin-experienced patients with nonvalvular atrial fbrillation. Am J Cardiovasc Drugs 15:205–211
Jahnen-Dechent W, Ketteler M (2012) Magnesium basics Clin Kidney J 5(Suppl 1):i3–i14
Jacobs V, Woller SC, Stevens S, May HT, Bair TL, Anderson JL, Crandall BG, Day JD, Johannıng K, Long Y, Mallender C, Olson JL, Osborn JS, Weıss JP, Tj B (2014) Time outside of therapeutic range in atrial fibrillation patients is associated with long-term risk of dementia. Heart Rhythm 11(12):2206–2213
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethics Approval and Consent to Participate
Informed consent was obtained from all participants and the Institutional Ethics Committee approved the study (approval number: 016/2020–15.04.2020). The study was conducted in accordance with the Declaration of Helsinki.
Conflict of Interest
The authors declare no competing interests.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Ardahanli, I., Akhan, O. & Celik, M. The Effect of Serum Magnesium Level on Stable Anticoagulation in Patients Using Warfarin for Various Cardiac Indications. Biol Trace Elem Res 200, 4297–4302 (2022). https://doi.org/10.1007/s12011-021-03036-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12011-021-03036-y