pellicle
Professional Dingbat, Guru and Merkintologist
firstly, I'm sorry that this post has a bunch of acronyms in it, I'll try to inline clarify them.
We'd all love things to be simple ... however often they're not (hello Tax time forms). Despite knowing things are complex we always seek simplifications to make explaining things easier. These simplifications often make extending what we "know" dangerous because what we (think we) know is based on a simplification (or a dumbing down).
With respect to warfarin, at the root of it all is this point: we are not totally sure how warfarin acts. We have a lot of evidence, but we aren't totally sure. So like paracetamol we just don't know for sure.
NB from MIMS
So the following article is of benefit to read, it makes the case clear that while vitamin K is a factor the actions of the body to rid itself of warfarin is the most significant factor.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2911546/
The article starts its abstract (the simple bit) with the following:
So knowing what are CYP2C9 and VKORC1 are key.
https://en.wikipedia.org/wiki/CYP2C9
and
https://en.wikipedia.org/wiki/VKORC1
Now if you look at the "dosing calculator" here (http://www.warfarindosing.org/Source/InitialDose.aspx) you'll see that it requires this as input (as well as your CYP2C9 genotypes
This is actually important but mostly never obtained because in the real world we can measure our INR and know the outcome.
What we can't know however is what the dietary effects on our VKORC actually is ... but we do know that many things inhibit it.
So accordingly I say that don't worry about your diet, only concern yourself with knowing your INR and making any changes to your dose to reflect what's happening (or in extreme cases stop drinking gallons of Grapefruit juice ;-)
Anyway, I strongly recommend you read that first article slowly and take it in. The advice is good: for instance:
We'd all love things to be simple ... however often they're not (hello Tax time forms). Despite knowing things are complex we always seek simplifications to make explaining things easier. These simplifications often make extending what we "know" dangerous because what we (think we) know is based on a simplification (or a dumbing down).
With respect to warfarin, at the root of it all is this point: we are not totally sure how warfarin acts. We have a lot of evidence, but we aren't totally sure. So like paracetamol we just don't know for sure.
NB from MIMS
So the following article is of benefit to read, it makes the case clear that while vitamin K is a factor the actions of the body to rid itself of warfarin is the most significant factor.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2911546/
The article starts its abstract (the simple bit) with the following:
So knowing what are CYP2C9 and VKORC1 are key.
https://en.wikipedia.org/wiki/CYP2C9
and
https://en.wikipedia.org/wiki/VKORC1
Now if you look at the "dosing calculator" here (http://www.warfarindosing.org/Source/InitialDose.aspx) you'll see that it requires this as input (as well as your CYP2C9 genotypes
This is actually important but mostly never obtained because in the real world we can measure our INR and know the outcome.
What we can't know however is what the dietary effects on our VKORC actually is ... but we do know that many things inhibit it.
So accordingly I say that don't worry about your diet, only concern yourself with knowing your INR and making any changes to your dose to reflect what's happening (or in extreme cases stop drinking gallons of Grapefruit juice ;-)
Anyway, I strongly recommend you read that first article slowly and take it in. The advice is good: for instance:
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