Does Vitamin D Supplementation Increase Procedural Bleeding Risk?
No, vitamin D supplementation does not increase procedural bleeding risk based on current evidence, and there is no guideline recommendation to discontinue vitamin D before procedures.
Evidence Assessment
The available clinical practice guidelines addressing procedural bleeding risk do not identify vitamin D supplementation as a risk factor requiring modification or discontinuation before invasive procedures.
Guideline-Identified Bleeding Risk Factors
Major guidelines consistently identify the following modifiable risk factors for procedural bleeding:
- Antiplatelet therapy and anticoagulation are the primary medication-related bleeding risks that require careful periprocedural management 1
- Acute kidney injury and chronic kidney dysfunction significantly increase bleeding risk and should be addressed before elective procedures 1
- Active infection increases procedural bleeding complications 1
- Nutritional deficiencies that guidelines recommend correcting include iron, folic acid, vitamin B6, and vitamin B12—notably, vitamin D is not mentioned 1
Research Evidence on Vitamin D and Bleeding
The limited research examining vitamin D and bleeding presents conflicting findings:
- One retrospective study in warfarin-treated patients found that higher vitamin D levels (≥30 ng/mL) were paradoxically associated with increased gastrointestinal bleeding compared to deficient levels 2
- However, this study has significant limitations: it only examined patients already on warfarin (a known anticoagulant), making it impossible to determine if vitamin D independently causes bleeding or interacts specifically with warfarin 2
- No studies have examined vitamin D supplementation and procedural bleeding risk in patients not taking anticoagulants 2
Contrast with Known Bleeding-Risk Supplements
Guidelines and research clearly identify supplements that do increase bleeding risk:
- Vitamin E should be discontinued perioperatively due to increased bleeding risk 3
- Garlic and hawthorn are strongly associated with surgical bleeding independent of anticoagulants 4
- Ginkgo biloba, turmeric, and ginger increase bleeding risk when combined with anticoagulants 4
The absence of vitamin D from these lists is notable and suggests it does not pose clinically significant bleeding risk.
Clinical Implications
Continue vitamin D supplementation through the perioperative period unless the patient is on warfarin and has vitamin D levels >30 ng/mL, in which case closer INR monitoring may be warranted 2.
Key Caveats
- The single study suggesting increased bleeding with vitamin D only applies to patients on warfarin therapy—this cannot be extrapolated to patients not taking anticoagulants 2
- Vitamin D deficiency is associated with increased infection risk, including driveline infections after cardiac procedures, suggesting potential harm from discontinuation 5
- Standard doses of vitamin D (800-5000 IU/day) used for musculoskeletal health have not been associated with bleeding complications 6