Vitamin K tablets

[jarno1973]

Dear Friends,

I am trying to find tablets with vitamin-K. I want to start taking these to reduce the effect of changes in my daily vitamin-K intake. Several members here are doing the same and apparently getting some benefit from it.

I have been searching for vitamin K only tablets and for multivitamin tablets with vitamin K in I but have so far not been succesfull.


Hope some people can share the brand and type of vitamin K tablets they are using.

Thanks Jarno

 

[newmitral]

Hello jarno,

I have been taking the Jarrow brand 90mcg vitamin K-2 (as MK-7) softgel tablets available on Amazon for about $13.50 for a bottle of 60 pills.

I moved up to the 90mcg Jarrow pills after first trying the 45mcg "Doctors Best" brand K2 pills (also available on Amazon). These did not provide much stabilization of my INR variations.

There are other posts on this forum that discuss why K2 may be preferable to K1.

My INR varies pretty dramatically from week to week (I've posted a graph elsewhere on this forum), but the low-dose K2 does indeed seem to be making a difference to help reduce the variations.

You do need to be careful not to take any of the very high dose vitamin K supplements if you are on warfarin. The low dose (approx. 100mcg and less) seem to be what the studies indicate will be helpful for stabilization.

NOTE: mcg = micrograms
anything that lists dose as milligrams(mg) is too much: 1 mg = 1000 mcg.

Too large a dose will start to interfere with and ability of warfarin to do its desired job.

 

[Protimenow]

Great advice. There ARE multivitamins that supply low dose (mcg) Vitamin K. These are probably also worth considering.

For myself, I'm lazy about taking medications that I don't really NEED to take - so OTCs like vitamins are not consistently part of my daily regimen (although they should be). If you've got the discipline to take a Vitamin K supplement - or a supplement that provides low levels of K, then you should probably go for it. (OTOH - if these multivitamins only supply less than the 90 mcg that you feel you need, they may not be of much value, either). If your diet includes good sources of Vitamin K, you may also have to watch your INR if you're taking the supplements, too.

 

[Blake777]

I take 100 mcg of vitamin K once a day to keep my INR stable, per the doctor I see. Get mine from herb store. Same as what the doctors ordered for me when I was first put on them.

 

[jarno1973]

Well..it was difficult to find a store which held the vitamin K. I ended up ordering from Singapore. I expected problems at Thai customs but it came right through. The tablets are vitamin K2 50mcg from Newton-Everett.

Now I am trying to think of a decent way to start them of without getting out of range. I think I will keep to the approach of increasing my warfarin from 8 to 8.5 mg per day. Then, since the warfarin takes some time to take effect and the vitamin K should act quicker, I will wait 1-2 days before I start with 1 x 50 mcg K2 per day. I hope then things will balance out. If it does not I expect the INR to end up on the high side, in which case I will probably move to taking 2x50mcg of K2 per day.

If anyone thinks I am taking the wrong approach, comments are very welcome.

 

[pellicle]

Hi Jarno

do you self test? If you did then I would monitor daily and observe. I occasionally choose to monitor daily when an event occurs, as much to see what happens as anything else (I believe that with the lags between adjustment and result that it is a bit fraught to do such tuning). The knowledge provided by daily measurements would be helpful. I would also chart it (excel does a nice job) and watch the curve. I would also start testing 2 days before starting the VitK pills. Personally I can't see how it would be worse than sitting down to a good spinach meal (and for instance there is a favorite of mine in Japanese cuisine with steamed spinach and katusuobushi which I used to eat an amount of ... but I digress). People here have reported seeing their INR drop as a result of eating foods that they did not anticipate having that effect. Still one does want to avoid any strokes

It is not my experience that warfarin (or even food related) changes take so long to effect INR. I know that it is commonly stated here as some sort of 'truth' but I believe that it is done so with the intention of preventing people from steering their INR all over the place when adjusting things (and perhaps because so few people here have actually taken the time to do daily monitoring.


Next I'd also wonder about this as warfarin antagonises the recycling of Vit K[sub]1[/sub] not Vit K[sub]2[/sub]. Interestingly it is Vit K[sub]2[/sub] that is linked to bone strength.

So it may not be that you get as substantial change as you may expect. Have you considered PM'ing theGymGuy to see what his procedure was?

I have considered going to the Vit K pills and seeing what happens but as yet I have not. Partially because I've had plenty of other problems that need managing in the last 2 years and partly because I'm not entirely sure there is a lot of benefit in it for me ... and then there is the "what if I can't get my Vit K pills" for some reason...

I would hope that you post your results here if nothing other than to perhaps assit others who follow. Certainly I for one will be interested in the results.

I'm sorry that I can not as yet offer you better guidance.

PS if you do self test, and you do decide to daily monitor then cycle through the fingers and do the sides (giving you two sides per finger) so you don't have one finger that's annoyingly sore for a week or so...

 

[Protimenow]

I'm mostly in agreement with Pellicle. I don't see much reason for obsessing over immediate changes as a result of your 50mcg dose. The Vitamin K WILL have an effect (though not always predictable) in a day or so - daily testing for a few days may not be a bad idea.

If you're more than three months post-op, your INR can probably safely drop below 2.0 for up to a week (or, perhaps even longer if you have an On-X valve), so the addition of Vitamin K shouldn't put you into immediate danger.

Personally, I wouldn't change my daily warfarin dose -- if I changed my warfarin dose and added Vitamin K, I wouldn't know for sure which thing caused the change. If you KNOW that you're fairly stable with 8.0, I'd continue with that, then see what effect the Vitamin K has on your INR. At that point, it may be easier to decide whether to up your warfarin dosage.

Frequent self-testing, until you are sure that your INR is in range, and that you know the correct dose, is a good idea when you make an addition like this.

I may start something with a bit of Vitamin K at some time in the future, and I will probably increase my testing frequency until I know the effects that the K has on my INR.

 

[jarno1973]

Thanks for the responses.

Maybe I will change to only taking the vit K. and self test a bit more before I do anything to the warfarin dose. It will definitely be nice to know how much effect the 50 mcg will have in points on the INR. The reason why I am considering to up my dose first is because at 8 mg I had been stable for quite a while at a fairly low INR between 1.9 and 2.2. I liked that range a lot but after having been on an antibiotic course, the INR went up quite bit and has been unstable ever since. Mostly readings are within range but it changes from top to bottom of range quite easily. My thought was that if the INR becomes more stable, it should end up in the lower range again. Add to that the effect of the increased vit. K. intake and it could result in an INR below 2.

I do self-test and I guess my approach to INR management can be called a bit un-conservative. I have done several tests with alcohol to see the effects on my INR. Initial test always showed that the results were quite minimal. I do however have the feeling that my recently much more unstable INR could have to do with alcohol intake as well. Where I initially was quite careful with alcohol intake I have started more and more to move towards a drinking behavior as I had before I ever had any heart problems. People must by now be thinking I am an alcoholic but that is definitely not the case. My regular drinking behavior would be that some days I would have no alcohol at all, some days I would have a few and once in a while I would binge and get drunk. If consistency is the key to a stable INR, this should definitely not help.

I really like that due to frequent self-testing I have been able to live without much restriction and was still able to keep my INR under control. I am however not yet satisfied and will keep exploring ways to live the life style that I want while on warfarin. The vitamin K supplements are part of this. I hope that the vitamin K will stabilize the INR in general due to less effect of changes in vitamin K intake through food. This should allow me to aim more accurately for my desired INR (2.2-2.3) which I prefer for when I am riding my motorbike.

Another thing I may want to try with the vitamin K is to counter the effect of alcohol intake on the INR. From my earlier test I had seen that the effect of alcohol on INR is not that big but with the recently more unstable INR I am starting to believe that the effect becomes more significant if a few days of drinking or excessive drinking happen close together. To counter this effect I am considering to take an additional 50 mcg pill in times that I drink more than usual.

Some may consider my approach unsafe but I feel that with self-testing and taking small steps at a time the risk can be quite well controlled. A big hurrah for self-testing!!! Now all I need more is a conclusion of the On-X trials allowing me to safely drop my INR to 1.5-2.0. 

 

[pellicle]

Hi Jarno

Maybe I will change to only taking the vit K. and self test a bit more before I do anything to the warfarin dose.

well its Vit K[sub]2[/sub] ... so as I understand it shouldn't effect your INR ... but I'll be curious to see your results.

I might even just do this myself ... even if you don't.

It will definitely be nice to know how much effect the 50 mcg will have in points on the INR.

well as you say your INR has been unstable for a bit, so it may not be so easy to know exactly what effect the K is having ...

The reason why I am considering to up my dose first is because at 8 mg I had been stable for quite a while at a fairly low INR between 1.9 and 2.2. I liked that range a lot but after having been on an antibiotic course, the INR went up quite bit and has been unstable ever since.

I'm also on antibiotics and my INR has been moving around like this:

these are weekly measurements since January
I am told by some that such a variation is quite normal and so don't fiddle to try to make it flat.

I have attempted 'adjustment' (you can see the small changes in dose in the brown line) and found that it just wasn't worth it.

I'm also on antibiotics (have been for 5 months and will continue for another 6 months perhaps) so I can't be sure that this isn't having an effect too. Hard to know.

Mostly readings are within range but it changes from top to bottom of range quite easily.

what is your target range?

My thought was that if the INR becomes more stable, it should end up in the lower range again. Add to that the effect of the increased vit. K. intake and it could result in an INR below 2.

Perhaps. I had surgery back in Feb and my Dr just took me off the warfarin (it was actually the heart surgeon who did the op) and didn't have me on heparin while my INR restabilised over another 3 or so days. I was under 2 for about 4 days. He didn't seem to think it was a panic. My valve is similar to yours, its a pyrolytic carbon type.

I do self-test and I guess my approach to INR management can be called a bit un-conservative. I have done several tests with alcohol to see the effects on my INR.

well unconservative or not, I think its important to know what the effects of things are. I do similar experiments upon myself so that I can learn. Sometimes the experiments are deliberate, other times I just take advantage of the fact that I simply forgot to take my warfarin.

Initial test always showed that the results were quite minimal.

that matches my own observations of alcohol and warfarin ... although I usually only drink red wine or Brandy.

I've found no significant change even when I've had the better part of a bottle in the course of an evening.

There will no doubt be people who consider me an alcoholic, but then if they met the alcoholics they'd probably be stunned.

Back a few months ago I just couldn't even have one drink. Even half a glass of beer would have my heart rate go up to 120 ... it was disturbing and a sign that it wasn't OK for me. So I stopped drinking anything for a few months.

in the last few months I'm finding that I can again have a glass or two of red in the evening without any ill effects.

Listen to your body is my view ...

I am however not yet satisfied and will keep exploring ways to live the life style that I want while on warfarin.

that's the spirit!!

This should allow me to aim more accurately for my desired INR (2.2-2.3) which I prefer for when I am riding my motorbike.

well personally I think that's a bit of a dream ... such a narrow range is bound to be difficult. Still if you can attain that then ... good for you!

Just don't be surprised if its a higher variation.

Anyway, who cares about your INR when riding a motorbike. I seem to recall you do motorcross ... well ... I never enjoyed coming off when I did MX, and now that I ride stuff on the tar, I like it even less.

A big hurrah for self-testing!!!

indeed!

best wishes

PS: I reply here so as to give you convesation on these topics, please don't think I am telling you what to do...

 

[Protimenow]

You're scaring me. Even with an On-X valve, which hasn't been proven safe at INRs below 2.0, you may not be safe if you try to keep your INR so close to 2.0. There's no REALLY accurate method for testing INR -- if your meter is reporting higher than actual values (as my InRatio did before I had a TIA), a 2.0 on your meter may actually be more like a 1.5 or so. Personally, I am not comfortable unless I'm confident that my INR is at least 2.5 - but I have a St. Jude valve. I'm not sure that you should be comfortable with an INR that is so close to (or below) 2.0.

I've lived with warfarin for more than two decades. I don't think that there's really any lifestyle change required if your INR just happens to be 2.5 or so. Until clinical testing actually demonstrates that it's safe to use an On-X with an INR below 2.0, PLEASE consider shooting for a higher range.

 

[jarno1973]

Dear Pellicle,

Thanks for your feedback.

Reading on the forum I got the impression that vitamin K2 would just be as effective as K1 to stabilize INR but that it has some additional benefits. Now you got me thinking and I will dig a bit deeper into the subject before I start off my tests. Reading posts from forum member "newmitral" I also get the impression that the K2 affects the INR. Could you please share where you got the information that K2 would have another effect on INR than K1?

My INR range is 2.0-3.0 and I realize that it will not be possible to keep my INR at 2.2-2.3 but aiming at that will hopefully allow to stay in the 2.0-2.5 range most of the time.

I am not worried about the fluctuations I have in my INR at the moment but I figure I can at least try to get better control over it. Being at the lower end of my range but within the limits I believe will be the safest option for me. Everyone needs to find the balance between risk for stroke and bleeding but I feel that I am more often at higher risk for bleeding events with the motorcross going on.

I have been below 2.0 one some of the follow up visits with my surgeon and he also seemed not so much concerned with it. I am also taking a daily aspirin and knowing that, one of the test groups in the On-X trials is on aspirin, has a target INR of 1.5-2.0 and those people are not falling victim to stroke (yet), gives me some comfort.

I like your testing statistics, especially having the graph of the INR against the amount of warfarin you take. I keep records but maybe should look at making something like that as well.

Regards,

Jarno

 

[jarno1973]

Hi Protime,

Appreciate your concern. I am not actually aiming at exactly 2.0 because than I would definitely drop below 2.0 at times. I just rather be at or lower than 2.5 instead of above.

I have checked my meter against lab results and the maximum deviation found was 0.2 and yes the lab came back lower than the result from the meter. I have also been spot on and had higher results back from the lab. All in all, from the results, I get the impression that my meter is pretty accurate.

Like said I am unconservative in my approach as where you probably are the opposite (considering you suffered a TIA maybe understandable) . May I ask, do you use the 3 meters also for the scientific side of it and your interest in the subject or do you feel you need 3 meters to stay safe? After your extensive testing and comparison there must by now be a meter that you consider the most accurate. Why not go with 2 of those if you want verification of your results? Would be interesting to see if 2 of the same meters give similar results each and every time as well.

Really appreciate the valuable information you always share with us.

Regards,

Jarno

 

[pellicle]

Hi

Reading on the forum I got the impression that vitamin K2 would just be as effective as K1 to stabilize INR but that it has some additional benefits.

it could well be ... I've no data on that. I just know that Warfarin interacts with K[sub]1[/sub] and from what I read research suggests that bone perhaps benefited from K[sub]2[/sub]

Could you please share where you got the information that K2 would have another effect on INR than K1?

Wikipedia's description matches the notes I have taken from MIMS, so seems reliable:

Warfarin and related 4-hydroxycoumarin-containing molecules decrease blood coagulation by inhibiting vitamin K epoxide reductase, an enzyme that recycles oxidized vitamin K[sub]1[/sub] to its reduced form after it has participated in the carboxylation of several blood coagulation proteins, mainly prothrombin and factor VII. Despite being labeled a vitamin K antagonist, warfarin does not antagonize the action of vitamin K1, but rather antagonizes vitamin K[sub]1[/sub] recycling, depleting active vitamin K[sub]1[/sub]

{emphasis mine}

so its my own 'deduction' that K[sub]2[/sub] should not effect INR directly because its K[sub]1[/sub] that is involved in prothrombin reactions, but may it have an effect on it via other reactions.

I just don't know ...

but I feel that I am more often at higher risk for bleeding events with the motorcross going on.

unless you rip your arm off the major issue as I see it (from bleeding) would most likely be head injuries and brain bleeds ...

I am also taking a daily aspirin

me too ... probably most of us here are ... but be careful ... aspirin "thins the blood" but does not act on coagulation in the same way. Aspirin inhibits platelets which is altogether different.

The antithrombotic action of aspirin (acetylsalicylic acid) is due to inhibition of platelet function by acetylation of the platelet cyclooxygenase (COX) at the functionally important amino acid serine529.

ref: http://www.ncbi.nlm.nih.gov/pubmed/9263351
also worth a look if interested https://en.wikipedia.org/wiki/Mechanism_of_action_of_aspirin

quite different to Warfarin workings

and knowing that, one of the test groups in the On-X trials is on aspirin, has a target INR of 1.5-2.0 and those people are not falling victim to stroke (yet), gives me some comfort.

early days ... its entirely possible that other factors are at work ... or just that they had strokes but didn't die ... read those results carefully.

I keep records but maybe should look at making something like that as well.

I just whack it in a spreadsheet when I do it. My Coaguchek XS also records the last 100 measurements so even if I don't bother to I can do it next time.

I have dropbox on my PC so I put it into a folder under dropbox so its 'backed up' every time it changes.

Just while I'm typing and have some of the documents open, something to question the wisdom that Vit K is the sole significant issue in bone health ...

A protective role for vitamin Kin bone health has been suggested based on its role asan enzymatic cofactor. In observational studies, vitamin K insufficiency is generally associated with lower bone mass and increased hip fracture risk. However, these findings are not supported in randomized controlled trials (RCT) of phylloquinone (vitamin K[sub]1[/sub]) supplementation and bone loss at the hip in the elderly. This suggests that increased vegetable and legume intakes may simultaneously improve measures of vitamin K status and skeletal health, even though the mechanisms underlying these improvements may be independent of each other. Menaquinone-4(vitamin K[sub]2[/sub],), when given at pharmacological doses, appears to protect against fracture risk and bone loss at the spine. However, there are emerging data that suggest the efficacy of vitamin K supplementation on bone loss is inconclusive.

"Nutrition Reviews" Vol. 66 (10):549-557

 

[jarno1973]

I have been searching the internet and am getting contradicting information.

I just took the first 50 mcg Vit K2 tablet, my INR is 2.6 and was 2.4 two days ago.

If Pellicle is right, there will not be much effect but then at least there are still the other benefits of the vit K2. I am kind of hoping to see similar effects as newmitral was describing in earlier posts/topics.

I found one piece of info on the web stating that the K2 would be much "stronger" than K1 and great care should be taken as a small dose of the K2 would be able to wipe out the effects of warfarin. Keeping my fingers crossed that is not true.

I will be back to inform everyone of the results.

 

[pellicle]

Hi

I have been searching the internet and am getting contradicting information.

a friend of mine often says: go not to the internet seeking yes or no; for you will find yes and no and every answer in between.

I just took the first 50 mcg Vit K2 tablet, my INR is 2.6 and was 2.4 two days ago.

ok ... so if the K[sub]2[/sub] was going to effect INR by going against what warfarin is doing then one would expect that it would lower INR. 2.6 from 2.4 is encouraging that it does not.

I will be back to inform everyone of the results.

please do

 

[newmitral]

Hello jarno,

Reading posts from forum member "newmitral" I also get the impression that the K2 affects the INR.

Reading your posts, and pellicle's, I feel it might be helpful to interject a few bits of info/opinion here.

I did a lot of research before starting to take the K2 supplement to help stabilize my INR. Many reports I found were scholarly studies from peer-reviewed journals, not just "some guy on the internet". I don't have those references handy, but I'll try to find and post them if I have time over the weekend.

I found one piece of info on the web stating that the K2 would be much "stronger" than K1 and great care should be taken as a small dose of the K2 would be able to wipe out the effects of warfarin. Keeping my fingers crossed that is not true.

The information I found (from memory, so I might be off a bit), was that K2 lasted much longer in the system than K1. It is not so much that it is "stronger" but that if you are taking it every day, the concentration will build up to a higher value in your body because your system doesn't clear it as fast. It is for this reason that I started out with the very low daily dose (45mcg) and have only recently built up to a daily dose of 90mcg.

so its my own 'deduction' that K2 should not effect INR directly because its K1 that is involved in prothrombin reactions, but may it have an effect on it via other reactions.
I just don't know ...

I previously posted my INR variations for a 6 month period in this post:

http://www.valvereplacement.org/forums/showthread.php?41441-frequency-of-testing&p=535642#post535642

You can see a fairly dramatic indication that K2 DOES impact INR in the tests on
2012-11-10 - INR = 4.4
2012-11-14 - INR = 2.8
2012-11-17 - INR = 4.3

When I measured (and confirmed) the 4.4 reading on Nov.10 (Saturday) I took some extra K2 pills to help bring the INR down quickly. I did also reduce my daily warfarin dose from 12.5mg to 6mg that Saturday evening, then back to normal 12.5mg Sunday onwards. The results on Nov. 14th, (the following Wednesday) of 2.8 are a combination of the reduced warfarin the previous Saturday, and the extra K2. By the next measurement on Nov 17th (Saturday) the INR was back up to 4.3, and my suspicion is that the extra K2 had by then been cleared from my body, and the INR went back up as a result. Admittedly, these results are anecdotal, not an analysis of the chemical mechanisms involved, but my personal experience leads me to conclude that K2 has an interaction similar to K1 as far as the INR and warfarin are concerned.

On a related note, I have subsequently tested whether cranberry juice might be the cause of the spikes in INR, a suspicion mentioned in that earlier post. Upon further testing, I can not confirm any correlation between cranberry juice and my own INR volatility, so that isn't the cause.

Further info:
On May 25th, 2013, I increased my daily K2 dose from 60mcg to 90 mcg. Statistically, for the weekly INR results between 2013-06-01 and 2013-09-21, my mean INR = 3.04 (my range is 2.5 to 3.5) and the standard deviation has dropped to 0.36 (it was 0.57 when I was taking 60mcg/day of K2 - the results posted in the other thread).
I also have achieved a new "personal best" of not going out of range - either above or below - for 7 consecutive weeks.

So, as far as my own personal experiment goes, I'm pleased with the apparent INR stabilization effects of the K2 supplement. If you are not experiencing the very large variations I had been seeing, swinging from above range to below range in a week with stable lifestyle, stable diet and no other medications, then I'm not sure the benefits will be as obvious. But, as long as you are careful, and test frequently, you should be OK. I did also check with my doctor before embarking on this experiment, and showed him the medical journal papers that supported the experiment, and he was in agreement. You may want to consult with your own doctor as well just to let him know.

While I did expect the K2 to require me to increase my warfarin dose, I only really went from 12.0 mg/day to 12.5 mg/day so the overall increase in warfarin dose was not that significant for me.

Again, these are just my own personal stats as a result of my experiment with the K2 supplement to stabilize my INR. Your own results may vary, and I would also be interested to hear how it goes for you.


Also, I think this thread:

http://www.valvereplacement.org/forums/showthread.php?37453-Vitamin-K2-and-Warfarin

might be the one where I first saw speculation that K2 might be beneficial for INR stabilization as well as other health benefits.

 

[Protimenow]

Thanks NewMitral -- seeing your long post makes me feel a bit less guilty about adding one of my own.

In response to Jarno's questions - I tested with multiple meters because I had a scientific interest in the accuracy of the meters and hoped to find the one that gave results that were closest to the lab results. I also realize that labs aren't always 'accurate' and that tests on blood drawn the same day by more than one lab can give surprisingly different results. There is, apparently, no such thing as 'accurate.' The basic goal is just to be comfortable with the idea that your INR is most likely IN RANGE.

Backing up a bit -- I went for a considerable period a few years ago without testing. Prior occasional tests before this period of stupidity suggested to me that my INR was stable with my then current dose, so I didn't think that it was important to verify that my INR REMAINED stable.

I started testing in 2009, using a ProTime meter. This was probably the first available 'home testing' meter, and I used it every two weeks or so -- and sometimes less frequently -- if I couldn't afford a new supply of strips. Performing a test with a ProTime meter is a bit of a pain relative to the newer meters -- it requires more blood than the other meters, you have to discard the first drop of blood, and it takes longer to get the results. I eventually 'upgraded' from a ProTime to a ProTime3 meter -- these used the same strips, but the 3 was newer, a bit faster, and a bit sleeker.

I was able to get an InRatio (the original model), and began testing with that meter. The tests are easier to run - requiring a smaller incision and less blood, and the strips are good for up to a year after they expire. They also don't require refrigeration (the ProTime strips require refrigeration). I switched to this 'easier' meter - and relied too strongly on its accuracy. When I was running low on strips, and couldn't afford more, my testing frequency went from once a week to once every ten days or two weeks -- to my peril. A 2.6 on this meter was actually lower, and I hadn't seen anything anywhere that noted that the InRatio meter gives results that are significantly higher than the lab. I relied on this meter to stay inside of my range -- but after my TIA, the hospital lab showed INRs of 1.8, and 1.7 the next day.

It was at that time that I began my quest for the most accurate meter.

Alere replaced the InRatio with an InRatio2 (most likely a refurbished unit, but I didn't care), and I started testing with that meter. I also was fortunate enough to be able to get monthly blood draws, with testing done at a hospital lab. The InRatio and InRatio 2 gave the same results, most of the time, and if the results on each meter varied, they didn't vary by much. I started using the InRatio 2 for most tests, and found that its results were ALWAYS higher than the labs. I occasionally also tested with the ProTime -- and its results were ALWAYS lower than the InRatio meters.

During the past year or so, I have been fortunate enough to get a Coag-Sense meter and, more recently, a CoaguChek XS. The manufacturers of the ProTime strips replaced my 3-channel strips - which I reported as possibly defective (they were) with the more accurate 5-channel strips -- but these take EVEN MORE BLOOD THAN THE 3-CHANNEL STRIPS and I rarely use it.

I also have a Hemochron meter - the kind used in hospitals and even during operations - but I have to make or buy a cable to reset it and the strips for testing, if it passes the quality control tests.

I usually do NOT test with three meters. I am comfortable testing with the Coag-Sense and the CoaguChek XS. In most cases, the Coag-Sense is somewhat lower than the lab results, and the CoaguChek XS is somewhat higher -- and the labs often come in as a near average value between the two meters. I'm comfortable with a 2.0 or higher on my Coag-Sense and, at this point, the test with the CoaguChek XS may no longer be as necessary, as long as I know that my INR, reported by the Coag-Sense is reportedly In Range (I shoot for 2.5-3.5, but a 2.0 or above with the Coag-Sense is good enough for me).

If I get a wide range separating the Coag-Sense and the CoaguChek XS, I may also test with the InRatio 2. On rare occasions, I may also test with the ProTime or ProTime 3.

I have maintained a spreadsheet recording every test that I've ever taken -- the meter or facility performing the test, my warfarin dosage, and other factors that may have some impact on my INR.

Once or twice, the Coag-Sense and InRatio 2 gave me results that were within .3 or so of each other. A few times, the InRatio 2 and CoaguChek XS gave me results that matched, or that were within .3 or so of each other. At times, though, the InRatio reported INRs that were considerably higher than the CoaguChek XS.

Also, at times, the InRatio (and occasionally, the CoaguChek XS) gave results that were in the high 4s. These results didn't match the Coag-Sense or the labs, and I'm not sure if the were easily explained. (I thought that anemia, or a high hematocrit, or other factor may have skewed the results on those meters). I haven't reviewed my notes relating to those really high test results.

In answer to your question - my goal for using more than one meter remains a) finding the most accurate meter (for me, at least. A particular meter may possibly be more accurate for some people than it is for others, based on other blood factors.), b) possibly helping to point others towards the most accurate testing method, c) making sure that my blood doesn't ever drop to a point where I am at risk of another TIA.

I've said this many times before, but, ultimately I would like to see a day when ANYONE who is taking warfarin can be tested weekly - either self-tested or at local clinics - and can get the testing and management based on ability to pay. With testing now running around $5 a test, and with a good percentage of patients already insured, the profits to be made from these tests should easily cover the few patients who can't afford the few dollars that they would otherwise have to pay for testing. As a public health issue, helping everyone on warfarin to avoid strokes or hemorrhagic events by regular, weekly testing, and appropriate management would probably be much less expensive, in money and suffering, than treating strokes or bleeds.

 

[newmitral]

I found at least one of the primary reference papers that got me started on the vitamin k2 experiment.

The article is from the journal "Blood" - published by the American Society of Hematology

The article is titled:
"Vitamin K-containing dietary supplements: comparison of synthetic vitamin
K 1 and natto-derived menaquinone-7"

The paper is online at:
http://bloodjournal.hematologylibrary.org/content/early/2006/12/07/blood-2006-08-040709.full.pdf

The menaquinone-7 is the K2, and that is why I chose the particular natto-derived MK-7 K2 supplements I did.

Particularly relevant quotes from that article are:

A major difference between both vitamin K species is the very long half-life
time of MK-7, resulting in much more stable serum levels and accumulation of MK-7 to
higher levels (7-8 fold) during prolonged intake. MK-7 induced more complete
carboxylation of osteocalcin and hematologists should be aware that preparations
supplying =50 µg/day of MK-7 may interfere with oral anticoagulant treatment in a
clinically relevant way.

-----------------

if taken on a regular basis - there is no
accumulation of K1 whereas MK-7 accumulates asymptotically during the first 2 weeks,
after which a steady state level is reached. At comparable intakes the final level of MK-7
was 7-8 fold higher than that of K1, suggesting that - if taken on a daily basis - 25 µg/day
of MK-7 is more efficacious than 100 µg/day of K1.

----------------------------------------

MK-7 is a 3-4 times more potent antidote for oral anticoagulation than is
K1. If expressed per weight, the efficacy of MK-7 in the liver is still 2.5 times higher than
that of K1. In a previous paper we have demonstrated that vitamin K1 supplements
containing =100 µg/day are not likely to result in clinically relevant disturbances of oral
anticoagulant therapy22. Extrapolating these figures it may be concluded that MK-7
supplements containing more than 50 µg/day may interfere with oral anticoagulant
treatment, whereas doses = 50 µg are not likely to affect the INR value in a relevant way.

--------------------------------------

Hematologists, on the other hand, need to be aware that relatively low doses
of MK-7 may have a larger impact on the stability of oral anticoagulation than vitamin
K1. Obviously a large study in patients on oral anticoagulant treatment is needed to
demonstrate the safety of even low doses of MK-7 in this population. Until that time we
propose to use an upper safety limit for intake of 50 µg/day for long chain menaquinones
(including MK-7) in patients on oral anticoagulant treatment. This dose is comparable
with the menaquinone content of 75-100 grams of cheese13; by intrapolation of the curve
in figure 4 such amount would lead to a disturbance of the INR value of not more than
10%, which may be regarded as tolerable in the management of oral anticoagulant
therapy. On the other hand, its long half life time suggests that regular intake of MK-7 in
combination with properly adapted coumarin doses may result in more stable INR values.

------------------------------------------------------


This jives with what I recall, and I'll post a few other medical journal references, if they are relevant, as I locate them.

 

[pellicle]

Hi

I found at least one of the primary reference papers that got me started on the vitamin k2 experiment.

glad to see another journal user (rather than "I read it on a website")

The article is titled:
"Vitamin K-containing dietary supplements: comparison of synthetic vitamin
K 1 and natto-derived menaquinone-7"

Natto .. interesting stuff ... smells like baby ****. It seems to have yeilded a few interesting chemicals though. This seems to be another one. I seem to recall that same company was involved with another extract from Natto which was aimed at lowering blood viscosity (gasp - an actual blood "thinner") that had some positive impact on heart disease too.

This jives with what I recall, and I'll post a few other medical journal references, if they are relevant, as I locate them.

that would be good

Can I ask, are you taking that derivative of K or are you taking K[sub]2[/sub]?

I ask because I feel that from a metabolic point of view its important. Also it doesn't help that there are similar names (probably the Old name vs the New name) to obscure what these are. Anyway, I did a little more extraction of information on the differences between the K groups to explain what I mean by that Wikipedia has a starting point.

Vitamin K is a group of structurally similar, fat-soluble vitamins that the human body needs for post-translational modification of certain proteins required for blood coagulation, and in metabolic pathways in bone and other tissue.

ok ... fat soluble is important, because its a way that the body can store it.

So to clarify a bit about the two form (1 and 2) essentially all the K group share a common head but a different tail:

So Vit K is:

Vitamin K[sub]1[/sub], ..., is synthesized by plants, and is found in highest amounts in green leafy vegetables because it is directly involved in photosynthesis. It may be thought of as the "plant form" of vitamin K. It is active in animals and may perform the classic functions of vitamin K in animals, including its activity in the production of blood clotting proteins. Animals may also convert it to vitamin K[sub]2[/sub]

ok, so our source of the stuff is from plants and 1 is the type we commonly ingest (but type 2 can be formed by bacteria in our colon which may be significant and may be contribute to why INR is effected by antibiotics.

Vitamin K[sub]2[/sub], the main storage form in animals, has several subtypes, which differ in isoprenoid chain length. ... are called menaquinones, and are characterized by the number of isoprenoid residues in their side chains

so its the tail which differentiates the sub-groups of K[sub]2[/sub].

Also here we see the clarification of phylloquinone (K[sub]1[/sub]) and menaquinones (K[sub]2[/sub]) I mention this because the totally unrelated names makes it appear there is a bigger difference than there is between the two types.

So 1 and 2 are the ones involved in the metabolisms we understand (and the others undoubtedly involved in something) but what we know little about yet. So, onto the derivatives:

Three synthetic types of vitamin K are known: vitamins K[sub]3[/sub], K[sub]4[/sub], and K[sub]5[/sub]. Although the natural K[sub]1[/sub] and all K[sub]2[/sub] homologs have proven nontoxic, the synthetic form K[sub]3[/sub] (menadione) has shown toxicity.

Now another point to clarify nomenclature (naming method):

Menaquinones are abbreviated MK-n, where M stands for menaquinone, the K stands for vitamin K, and the n represents the number of isoprenoid side chain residues. For example, menaquinone-4 (abbreviated MK-4) has four isoprene residues in its side chain

I believe that this means that Vit K[sub]1[/sub] it not named with any MK designation.

ANYWAY ... the reason for all this is to make clear the various K forms as any exploration of how they relate to metabolism will need this.

phew ... sorry

 

[pellicle]

Hi

I found at least one of the primary reference papers that got me started on the vitamin k2 experiment.
The article is titled:
"Vitamin K-containing dietary supplements: comparison of synthetic vitamin
K 1 and natto-derived menaquinone-7"

reading that the first thing that comes to mind is this in their abstract:

The purpose of this paper was to compare in
healthy volunteers the absorption and efficacy of K[sub]1[/sub] and MK-7.

nothing on what MK-7 effects are vs (say) MK-4 ... so, more reading for me then ;-)

also in methods:

All volunteers (equal numbers of men and women) were apparently healthy and between
25 and 35 years old.

the numbers of volunteers is quite low too ..
study 1

Fifteen volunteers were enrolled in this study.

study 2

Ten volunteers were enrolled for this experiment.

study 3

Eighteen volunteers were randomized to take 0.22 μmol/day of either K1 or MK-7 in a cross-over design.

study 4

Twelve subjects (mean age: 34.2 ± 6.4 years, mean body mass index: 23.5 ± 2.6) were

so not to say that it is wrong or bad, but I do wonder about the transferability of this data to the broader population.

Most studies would have much larger groups involved is all...