warfarin and side effectts

[skrob49]

My 60yr old wife had AV replaced with St Jude Regent 19mm on 6thAug 2010. She is now taking 2mg warfarin daily.
I have noted recent reports of artery calcification and osteoporsis associated with warfarin. I understand that Vit K is necessary for vascular and bone health.
My question is can she take more leafy greens to increase Vit K intake and then drink some, say, cranberry juice to balance the effects of warfarin. I are not inclined to increase the warfarin dosage.
Any one has experience in such balancing acts ? Comments much appreciated.
skrob49

 

[Bina]

Hello and welcome.
I'm not ready to blame the warfarin for my valve calcification and osteoporosis since I had both of these issues before I ever started taking the warfarin.
My first year postop I was very nervous to eat greens but I soon learned that I was missing out on valuable
nutrients in broccoli, asparagus, spinach, etc. So now I enjoy a small portion of these items a few times a week
and I don't need a high warfarin doseage either. I am taking 18 mg per week; very similar to your wife's dose.
I skip the cranberry juice and I skip caffeine and alcohol.
How is your wife's INR level doing?

 

[ALCapshaw2]

Studies have confirmed that it is Easier to maintain one's desired INR Target Range while consuming a CONSISTENT level of Vitamin K as opposed to trying to completely avoid Vitamin K. We (VR members on Coumadin) call it "Dosing the Diet rather than Dieting the Dose".

Consider the analogy of walking into a Dark Room (i.e. avoiding vitamin K)
and then turning on a 50 Watt Light (i.e. consuming some vitamin K).
HUGE DIFFERENCE.

Now consider walking into a room with a 50 Watt Light Illuminated.
Then switch to a 100 Watt Light. SMALL INCREASE.
That is analogus to consuming a Consistent Level of Vitamin K and then eating a Larger amount of Vitamin K in a Large Spinich Salad, etc. NO BIG DEAL.

The Key is to find the amount of Coumadin / Warfarin needed to maintain a stable INR within the target range while consuming a consistent level of Vitamin K in the diet. Most of us do this by just eating "something green" every day.
NO BIG DEAL.

At 2 mg per day, your wife is taking a VERY LOW Dose of Coumadin.
BTW, dosing is usually based on the Weekly Total and again, most of us find that SMALL changes are all that is needed for minor changes outside our target range.

You and your wife may want to obtain a Dosing Guide.
Several references have been posted previously but I can never remember the links (sorry).
My Dosing Guide seems to no longer be available for sale.

'AL Capshaw'

 

[dick0236]

Warfarin is an anti-coagulant that is used only to keep a patient protected from stroke. Your wife has an INR range, probably, of 2-3 or 2.5-3.5. It is necessary that she stay in this range. If she wants a hi vit K diet, it may be necessary to increase the warfarin dosage to maintain her INR range. There is no magic dose for warfarin...you take what is needed to stay in your INR range. I have been on the drug for 43 years and have no indication of artery calciffication or oseoporsis. I have always eaten a normal diet which has alwayse included vit K vegs several times per week.

FWIW, I have never experienced ANY side effects from Warfarin.

 

[Philip B]

Diet?

Diet?

Listen to Al... he knows what he's talking about.

Eating what you please and adjusting coumadin dosage to keep you in range is much easier than trying to manage coumadin dosage with diet. Adjusting dosage isn't hard and doesn't require complicated math.

-Philip

 

[skrob49]

Hello and welcome.
I'm not ready to blame the warfarin for my valve calcification and osteoporosis since I had both of these issues before I ever started taking the warfarin.
My first year postop I was very nervous to eat greens but I soon learned that I was missing out on valuable
nutrients in broccoli, asparagus, spinach, etc. So now I enjoy a small portion of these items a few times a week
and I don't need a high warfarin doseage either. I am taking 18 mg per week; very similar to your wife's dose.
I skip the cranberry juice and I skip caffeine and alcohol.
How is your wife's INR level doing?

So far three weeks post op., INR between 1.9 to 2.3 with target 2 to 2.5. But would like to pack in more broccoli and spinach to get more vit k. Thanks, heartening to know that u can do it with little adjustment to warfarin dosage. Will report back after adding increasing intake.

 

[Cris N]

Absolutely, she should eat those greens - and then her warfarin dosage will be adjusted proportionately. Please don't count on using cranberry juice to counter balance the vit. k in the veggies. Warfarin is much more effective and easier to control.

FWIW - I have not experienced any side effects from taking warfarin.

 

[skrob49]

Studies have confirmed that it is Easier to maintain one's desired INR Target Range while consuming a CONSISTENT level of Vitamin K as opposed to trying to completely avoid Vitamin K. We (VR members on Coumadin) call it "Dosing the Dies rather than Dieting the Dose".

Consider the analogy of walking into a Dark Room (i.e. avoiding vitamin K)
and then turning on a 50 Watt Light (i.e. consuming some vitamin K).
HUGE DIFFERENCE.

Now consider walking into a room with a 50 Watt Light Illuminated.
Then switch to a 100 Watt Light. SMALL INCREASE.
That is analogus to consuming a Consistent Level of Vitamin K and then eating a Larger amount of Vitamin K in a Large Spinich Salad, etc. NO BIG DEAL.

The Key is to find the amount of Coumadin / Warfarin needed to maintain a stable INR within the target range while consuming a consistent level of Vitamin K in the diet. Most of us do this by just eating "something green" every day.
NO BIG DEAL.

At 2 mg per day, your wife is taking a VERY LOW Dose of Coumadin.
BTW, dosing is usually based on the Weekly Total and again, most of us find that SMALL changes are all that is needed for minor changes outside our target range.

You and your wife may want to obtain a Dosing Guide.
Several references have been posted previously but I can never remember the links (sorry).
My Dosing Guide seems to no longer be available for sale.

'AL Capshaw'

Great, yah, "dose the diet". I suppose it would be okie, to increase the greens and then take a little bit of cranberry and CoQ10 and then check INR and dose accordingly ??

 

[kfay]

Just be careful about introducing too much vit k without increasing her dose as your wife is already on the low end of her range. Most of the people on here who take warfarin prefer to be on the upper end because that gives you a little more wiggle room. You don't want her having a stroke. Also, she is still pretty new post op and as she becomes more active, her INR may start to drop on its own without those dietary changes you mentioned.

 

[skrob49]

Warfarin is an anti-coagulant that is used only to keep a patient protected from stroke. Your wife has an INR range, probably, of 2-3 or 2.5-3.5. It is necessary that she stay in this range. If she wants a hi vit K diet, it may be necessary to increase the warfarin dosage to maintain her INR range. There is no magic dose for warfarin...you take what is needed to stay in your INR range. I have been on the drug for 43 years and have no indication of artery calciffication or oseoporsis. I have always eaten a normal diet which has alwayse included vit K vegs several times per week.

FWIW, I have never experienced ANY side effects from Warfarin.

Oh man, 43 years post AVR and on warfarin, you are an icon!! We have been worried sick about this sensitive devil As a golfer, we would say "play one shot at a time". Thanks pal, but perhaps should keep an eye on the arteries and the bones, no harm to be cautious - the pessimist in me again

 

[skrob49]

Absolutely, she should eat those greens - and then her warfarin dosage will be adjusted proportionately. Please don't count on using cranberry juice to counter balance the vit. k in the veggies. Warfarin is much more effective and easier to control.

FWIW - I have not experienced any side effects from taking warfarin.

Great news, about not having any side effects for so many years. When we make diet changes, roughly how many days do we expect INR changes??

 

[skrob49]

Just be careful about introducing too much vit k without increasing her dose as your wife is already on the low end of her range. Most of the people on here who take warfarin prefer to be on the upper end because that gives you a little more wiggle room. You don't want her having a stroke. Also, she is still pretty new post op and as she becomes more active, her INR may start to drop on its own without those dietary changes you mentioned.

Great point, I have been told to be a little on the upper limit of INR target is more comfortable. Damaged brain cells cannot be replenished. Oh, I did not know that it is likely that INR may drop during the recovery stage, must take note of that, Thanks

 

[Lily]

I just want to tell you that I'm impressed with you helping your wife figure this all out. Very nice loving support

 

[Freddie]

Great news, about not having any side effects for so many years. When we make diet changes, roughly how many days do we expect INR changes??

It takes about 3 to 4 days for a new dosage to be fully into your system, so testing once a week until the INR is stablized with the new dosage is usually the norm.

and....just to clarify what kfay said about INR dropping during recovery: as the body heals and becomes more active the INR levels may drop, but this may not happened for 4 to 6 weeks after surgery.

 

[ALCapshaw2]

So far three weeks post op., INR between 1.9 to 2.3 with target 2 to 2.5. But would like to pack in more broccoli and spinach to get more vit k. Thanks, heartening to know that u can do it with little adjustment to warfarin dosage. Will report back after adding increasing intake.

I'm surprised her Doctor gave her such a narrow range. Most people who have been on anticoagulation find that it is Very Hard to manintain such a narrow range considering the measurement tolerance and personal variations. Many of us on this site consider anything between 2.0 and 4.0 to be the 'Safe Zone' and don't get overly concerned with any readings within that zone.

FYI, the usual guidelines for an Aortic Valve Replacement with NO addifitonal Risk Factors is 2.0 to 3.0 in the USA.
Patients with Additional Risk Factors (history of stroke or TIA, clotting issues) are usually advised 2.5 to 3.5.

The usual guidelines for a Mitral Valve Replacement with NO additional Risk Factors is 2.5 to 3.5 in the USA.
Patients with Additional Risk Factors are sometimes advised 3.0 to 4.0

Adjustments for Small Variations out of range are adjusted with SMALL changes in the Weekly Dose
(many use a 5 to 10% dose change, sometimes 20% for larger adjustments) followed by retesting in 1 to 2 weeks. Testing Too Often and Adjusting Dose Too Often is a Leading Cause of the "Roller-Coaster" Effect in INR and a sign of a poorly trained anticoagulation manager.

'AL Capshaw'

 

[Cris N]

Just my opinion but before I would start adding a lot of greens to her diet, I would get that INR up to the high end of the range (which I agree should probably be higher - I thought the recommended for AV was 2-3). Some people are more sensitive to dietary changes and the effect on INR - and added to the fact that her INR will probably drop due to increased activity - you might want to make gradual changes.

 

[hook]

I found that I needed less Coumadin to get the same INR after putting 4 grams of fish oil in my diet. The fish oil is a natural blood thinner, so I would rather get to my target with something healthy, requiring less medicine. You may ask your wife’s Doc about Levesa, a prescription fish oil. You may also do some research into Vit K2; I don't think it affects your clotting mechanism as much, but is very effective at removing calcium deposits from artery walls. If someone knows more specifics please chime in. If I had a tissue valve, I would be taking all the K2 I could. That's just me though.

 

[ALCapshaw2]

Hook -

Have you informed your Cardiologist that you are taking 4000 mg of Fish Oil?
Mine recommended no more than 1000 mg / day.
He also recommends no more than the RDA of Vitamin E and CoQ10 (hope I remembered that correctly).

 

[skrob49]

I just want to tell you that I'm impressed with you helping your wife figure this all out. Very nice loving support

Thanks indeed for your kind works. She believes in "the doctors are paid to worry about her health" and "Ignorance is bliss" LOL

 

[skrob49]

I found that I needed less Coumadin to get the same INR after putting 4 grams of fish oil in my diet. The fish oil is a natural blood thinner, so I would rather get to my target with something healthy, requiring less medicine. You may ask your wife’s Doc about Levesa, a prescription fish oil. You may also do some research into Vit K2; I don't think it affects your clotting mechanism as much, but is very effective at removing calcium deposits from artery walls. If someone knows more specifics please chime in. If I had a tissue valve, I would be taking all the K2 I could. That's just me though.

Absolutely, I have also been thinking of getting to around INR of 3 and then adding greenies. Is the fish oil, OMEGA 3 ??