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Doctors' Answers to "Frequently Asked Questions" - Coumadin
These comments are made for the purpose of discussion and should NOT be used as
recommendations for or against therapies or other treatments. An individual patient is
always advised to consult their own physician.
Question: Will undergo surgery to replace mitral valve shortly. Will most likely have to have an artificial valve. Will have to be on coumadin the rest of my life with the artificial valve. Will I be able to get pregnant being on coumadin? I was told about a drug called Haprenol? or something like that. Any help would be appreciated.
Answer: Pregnancy with coumadin is possible, but we usually use heparin or low molecular weight heparin. You might want to discuss this with a high risk ob/gyn specialist they can give you the details, but this is able to be done.
Question: Hello Sir
A close relative of mind had a St. Jude valve replacement and is currently balancing out the blood thinner readings. Knowing my friend, he probably did not disclose the fact that he smokes marijuana, usually once or twice a day! Considering this fact, is there any contraindications when prescribed coumadin and routinely using marijuana!
Thank you and keep informing us with your knowledge!
Answer: Not usually.
Question: My mother was recently hospitalized for atrial fib.
Upon her release her cardiologist prescribed several medications.
Coumadin was one of them, somewhere along the line she heard that
Coumadin was like rat poison in when ingested in large quantities
a person would hemmorhage just as a rat would. She is very concerned
about this. If possible could you please tell me what exactly is
in Coumadin? If not, where can I go to find out what is
in it. Tahnk you for your time. Looking forward to hearing from you.
Answer: PLenty of information on the site as well as the FAQs. Coumadin is used for rodent poisoning,but at 50-1000 times the dosage that humans receive. She will need regular testing of her levels which her physician will do depending on the variability that she exhibits. She needs to avoid any aspirin or non-steroidal anti-inflammatories(motrin, aleve and the like). If she starts/stops any medication she needs to let her md know so that her levels can be checked. If she sees any bleeding she should call her md. Her blood will still clot, but in a different manner and a different speed.
Question: I had surgery in 1997 to repair a tear in my left leg(quadricep). Aproximately 3 months later I developed and neglected a blood clot. A DVT. I was hospitalized and given Heprin. I was put on Coumadin and I am still on it. Will I have to be on it for life? Are there herbs to take as an alternative? I have read about Horse Chestnut. What is a greenfilter and can it help me? I had a venus dopler about a year ago and the clot was still present, although reduced.
Answer: Unless there is an underlying mechanism causing the recurrance of clots, most physicians would stop the coumadin after six months regardless of whether there is residual clot on the ultrasound. There will be a risk of reoccurance with this, less if you take an aspirin once a day, but acceptable considering the risk of coumadin for bleeding. If you have a reoccurance off the coumadin, most would recommend long term coumadin. Horse chestnut is for chronic venous stasis , I have not seen studies on DVT per se. A greenfilter is placed in the inferior vena cava to stop the clots from migrating to the lung. This is used in patients who cannot use coumadin(immediately post neurosurgery for example). If you have not had a pulmonary emboli, of little use currently.
Question: I happened upon your site while looking for references for my patients. Thank you for your rational responses regarding warfarin and green leafy vegetables. It is much safer and easier for the clinician to adjust the warfarin dose to the patient's diet (assuming a consistent amount of vegetable intake) than it is to expect a person to radically change their diet and avoid common foods, putting themselves at risk for deficiencies in vitamins and nutrients other than vitamin K. Just a few comments on some related issues that have come up on your site with frequency: I have had patients who have had bleeding problems when they took more than 100% of the RDA of vitamin E in addition to their normal dietary intake while on warfarin. Conversely, I have had patients who have dropped their INRs after eating garbonzo beans (chickpeas) or drinking UNFILTERED tea(especially green tea).
By the way, anyone taking a multivitamin should check the label for vitamin K content every time they buy a new bottle. Companies often change the amounts and even types of vitamins in their tablets, sometimes without any notice to the consumer. And different companies have different mixes. I have had 2 patients come in with low INRs, apparently related to addition of vitamin K to the vitamin brand that they had been taking for years.
Speaking of vitamin companies, several of them have gone into the herbal business. Many of the herbs contain natural coumarins or have anti-platelet activity. Since the FDA hasn't started regulating the concentration or purity of herbals, the actual strengths of these substances can vary widely from company to company, and even from lot to lot from the same company. Have you noticed any increase in INR variability or bleeding events in your patients that take herbal supplements?
Answer: Occasionally,the hard part is getting the history since they often do not consider that these are "medicines" or could have any effect on their life. Thanks for the note.
Question: Anti-inflamatory medication? Because I take Warfarin, I know that I am very limited in what NSAIDS I can take, and that steroids are not an option. My doctor recently placed my on VIOXX which I discontinued after several days of excalating stomach distress - nausea, reflux, milk diarrhia, and gas. Sorry about my spelling. Can you suggest any medication that would not be in conflict with the Warfarin?? Thank you for your advice. And, I will let my doctor know tomorrow that I have discontinued the Vioxx.
Answer: Any Non-steroidal anti-inflammatory will cause a potential interaction. We tend to use suldinac but, it is not without risk.
Question: My father had aortic valve replacement surgery Nov 1,1999 and began Coumadin about 3 days later. Ever since it has been a rollercoaster ride trying to regulate is INR. His cardiologist adjusts the dosage about weekly still and we can't figure out why it goes from perfect one week to 8.9 the next with no change in diet. Also he began coughing up blood a few days ago. Is that something that the doctor should look into or is it normal when your INR is that high? He is wondering if this is normal to have such a problem to regulate this drug? Needless to say he is tired of being stuck all the time. Please give us some insight on this.
Answer: Unless he is changing other medications, it is usually not a big deal to regulate.
Question: I had aortic composite graft surgery in November of 1999.Since I have a mechanical valve the dotor put me on 5mg.of coumadin a day. My question is that I have been waterskiing for about 30 yrs. If I ski conservatively and on smooth water I very seldom fall. I hate to give up skiing if the risk is very small for problems relating to the comadin. Iwould like your opinion.
Answer: There is a risk of bleeding post-trauma that you can't avoid. Carry some ice in the boat to help the clotting if you do have a more serious fall and don't ski stupid. You will be at risk but minimal.
Question: I would like to know what the standard of care is regarding a patient on coumadin undergoing oral surgery (for gingivitis)Is it always held, and if so for how long?
Answer: This would depend a lot on why they are on the coumadin. Usually for low risk patients(atrial fibrillation etc.) we stop it 3-4 days prior to any oral procedures. For high risk patients(metal valves, etc) we stop it 2 days prior to dental procedures. Since the gum is accesable, pressure can be applied and stop bleeding in the event there is excessive bleeding. So, it is less of a bleeding risk than an internal procedure like a biopsy.
Question: i am a 38 yr old female that has had aortic vavle replacement in feb.1998 i take 10mg coumadin a day.. i have very very bad leg cramps when i lie down.. i have told my doctor about this and he has given me k+ and quinine and this has done no good.. i know i have to take the coumadin but just to see when i skip my coumadin my legs do not cramp.. they hurt so bad that it feels like the veins are jumping around when they hurt and i dont know what to do about this thank you
Answer: This is really a large dosage of coumadin, what is your INR?
Question: I am on Coumadin and Aspirin for TIA's. What product are OK for use to treat sinus headache, running nose, watery eyes while on these medicines? What about the common cold--what products would be OK for use while on Coumadin/Aspirin?
Answer: You should always check with your doctor. Antihistamines should be ok, but any drug addition to your current drug list can change metabolism and require closer monitoring of the coumadin(INR) levels.
Question: Do I need to temporarily stop my patients' coumadin before dental procedures? If so, how soon in advance of the dental procedure. Does it depend on why they are on coumadin therapy as to whether it is safe to stop coumadin for the procedure. For example, the patient that is on coumadin for atrial fib versus a patient on coumadin for a left venticle thrombus? Should the patient with the thrombus be managed in the hospital? Appreciate any guidance or articles that you could direct me to. Thanks, Tonya FNP
Answer: Yes, usually four days is sufficient. Cleaning alone does not usually require this unless there is a history of excessive post cleaning bleeding(usually only seen with severe gum disease). This is never done in the hospital, if there is a severe risk-subcutaneous low molecular weight heparin or regular heparin can be used for the gap. But, rarely a problem.
Question: My mother just recently had a greenfield vena cava filter implanted. The doctors deemed this necessary after finding a blood clot in her pelvis, and a few emboli in her lungs....she had been on heparin shortly after they found the clot in her pelvis. She was told at first she would need to be on coumadin for about 6 months, now they tell her it will be necessary to take it for the rest of her life. She is not elderly (only 47) and walks daily, so inactivity is not a problem. She also currently has a colostomy bag due to complications of another surgery. She is schuduled for reversal in 3 weeks. My questions are: is it really necessary for her to be on coumadin for the rest of her life and should she be taking blood thinners before this upcoming major surgery?
Answer: Depends a lot on why the doctors thought she should be on coumadin, that is what was the cause of the clot? The filter will work to "catch " emboli from below,although after a few years there are reports of bypass veins growing and allowing repeat emboli. I'll need to know the reason for the emboli. As to the surgery, it should be stopped 4-6 days prior to surgery.
Coumadin and Vitamin E [posted
Question: I have been taking coumadin for several years and am currently taking 7.5
mg daily. I have had open heart surgery to remove the back of my heart, a 4 level bypass,
and insert a ventricular defibrillator. I have also had 2 major strokes (the first at age
38), hence the coumadin. In spite of this I feel my health is currently good. I exercise
(aerobic) every day, eat correctly and would like to be more in control of my health. I
heard about the wonderful effects of Vitamin E but have heard that it is contra-indicated
when taking coumadin. Is this true? I have also heard that it is beneficial to take ginko
buloba to improve brain circulation, but care must be exercised when taking coumadin. Can
you give me some more information on this? I am a male, 57 years old and have been blessed
with very good care. I would just like to be able to take things more into my own hands.
Also, I recovered from a severe case of polio as a child and wondered about the effects of
polio on the heart since it is a muscle as well.
Answer: Polio does not affect the heart, the virus lives in the spinal cord and
causes de-enervation of the muscle, which the heart does not have. There should be no
problem with Vit E and the coumadin. As to the ginko, I have no information. Just watch
your pt/INR, closely after starting it.
Coumadin Alternatives [posted
Question: I am getting ready to have AVR. I have been very concerned about living
on Coumadin. I have had two doctors tell me not to dwell on this because Coumadin should
be replaced within 3 to 5 years. Is this true? If so with what and how will it work?
Answer: Maybe, maybe not. But, if you are getting a valve replaced, you have
few/little option. While it is a pain to get regular testing, it is the only way to
decrease the risk of bleeding or insufficient anticoagulation.
Coumadin Side Effects [posted
Question: What are the common side effects of coumadin? It was prescribed for my
father-in-law after he had a light stroke 5 months ago.
Answer: Coumadin (warfarin) has generally few side effects. It should not be
used during pregnancy due to birth defects. There are occasional severe cases of skin
necrosis, also a strange phenomenon called purple toe syndrome wherein the feet
(generally) develop tender purple spots. There is a long list of occasionally reported
items, but generally not enough to discuss. The biggest risk is excessive bleeding and
interaction with drug metabolism causing other drugs concurrently being taken to rise/fall
out of therapeutic range.
Coumadin [posted 8/13/98]
Question: I have been taking Coumadin for approximately eight months. I have just
gotten permission from my doctor to resume taking Vitamine E and Calcium. What is your
opinion of Grape Seed Extract? Would it be safe to take with Coumadin? I am a 56 year old
female. I am taking Coumadin because of vasculitis.
Answer: As long as you take regular dosages, you can take most medications with
coumadin without problem. The problem arises if you take a large dose one day (or for a
week) and then none for a while. The dosage of coumadin can be adjusted for almost any
metabolic problem as long as the problem is relatively fixed.
Coumadin Levels [posted 8/11/98]
Question: My father is on coumadin and has asked me to ask for information
regarding the level. His doctor wants his pro time between 2 and 3. Yesterday it was 3.1.
With the pro time increasing, he wants to know if the coumadin needs to be reduced or
increased to keep pro time below 3.
Answer: I think you are referring to the INR rather than the protime. A higher
INR necessitates a lowering of the coumadin, a low INR raising the dosage. The level of
the INR depends a lot on why he is taking coumadin - the higher the INR the
"thinner" his blood.
Coumadin [posted 8/6/98]
Question: I am a 50 year old male. In January 1996 I had a St. Jude aortic valve
implant. I was prescribed coumadin. The doses have ranged from 10 to 15 mg/day. I have
been tested regularly, but have continued to fluctuate from too high to too low. Several
weeks ago I passed out (1-3 minutes) after severe leg pain and was hospitalized. A Brain
Scan, CT Scan, and Lung scan all were negative. INR=1 in the emergency room. They kept me
on heparin while they waited 4 days for coumadin to come up to INR=1.9. What can I do to
avoid another vacation?
Answer: I'm kind of baffled concerning your coumadin needs. This is a large
dosage - depending on where your doctor wants to keep your INR. Are you taking other
medications that are competing with the coumadin? This is peculiar and needs further
evaluation by your doctor.
Coumadin and Atrial Fibrillation
Question: If a patient has been on coumadin for several years and is taken off,
cold turkey (not reduced), and just stopped for five days and on the 6th day the patient
suffers "sudden death" caused by atrial fibrillation would taking him off
coumadin have been the cause?
Answer: Coumadin will usually have some effect for 4-5 days after cessation
depending on the initial INR and the patient's metabolism. If the death was due to an
embolic event from the heart thrown to the brain - possibly.
Hair Loss from Coumadin [posted
Question: My cardiologist has put me on coumadin because of an irregular heartbeat
and told me that I have to take this the rest of my life. Aspirin will not suffice. I am a
woman, 54, and since I have been on this, I have been losing significant amounts of hair
daily. I would like to find an alternative to coumadin, perhaps using vitamin/mineral
therapy. I have read that vitamin E thins the blood and that zinc deficiency can cause a
hair loss. Is the coumadin interfering in the body's ability to use the zinc in my current
supplements and in my diet? I am taking 300% of the RDA of zinc and 100% of RDA of vitamin
E. If there in no alternative to stopping the coumadin, can larger doses of zinc help stop
the hair loss? Do other vitamins or minerals play an important part in hair loss?
Answer: Are you taking any other medications? Because coumadin is pretty risk
free, I suspect another medication, like a beta blocker is the culprit. However, I know of
no interaction with zinc in coumadin action and I don't think zinc would be of any use.
Women do have good responses to topical minoxidil. If you can't eliminate the drug, try
Loss of Taste and Coumadin
Question: I took Coumadin because I had arrhythmia. I underwent Cardioversion and
now I have a normal heart rhythm. I stopped taking Coumadin on advice or permission of my
doctor. I feel that Coumadin was responsible for a loss or perversion of taste. I no
longer take it. It has been about 3 weeks since my last dosage. It is difficult to tell
whether my taste has really improved. What are the statistics on this? I am 73 and have
lost a lot of weight with intent. However, I want to taste again. Could this be genetic?
My Dad talked about it before he died at 75. He said he could taste the first four bites
or so, but he was on medication for high blood pressure. I understand that a side effect
of blood pressure reducing pills is loss of taste. I used to take Vasotec. That loss of
taste is shown to be a side effect with that drug. I have not taken it for a good length
of time. With my loss of weight I have normal blood pressure.
Answer: Taste like any sensory nervous input is prone to degradation with age.
Sight and hearing have obvious decline with aging. However, taste and smell do as well.
While different medications can affect taste/smell, I wouldn't expect the effect to last
more than a couple of weeks after the drug is discontinued. I have not had any patients
complain of loss of taste with coumadin, but anything is possible. There are clinics that
can quantify your taste/smell ability and loss. I have not been impressed that they offer
good treatment alternatives.
Coumadin [posted 7/21/98]
Question: My husband has been on Coumadin, following the installation of a stent.
He is 62 years old and still active. The effects he's been noticing are: At therapeutic
levels of Coumadin, (the levels some doctors insist on) he experiences joint pain, which
interferes with his sleep as well as his activity level. If the level drops too low,
(below 13) he experiences atrial fibrillation. I have not seen any information that
mentioned the joint pain as a side effect. Have you heard of this before? His other
medications have not been changed recently. He is considering a bypass.
Answer: Would certainly be uncommon. I'd have him see a Rheumatologist
(arthritis specialist) to find the cause. I strongly doubt that it is the coumadin.
Coumadin and Tylenol [posted
Question: Recently I was told that there was a news article warning people on
coumadin not to take tylenol. I can't find any information on this.
Answer: There was one article that studied patients who presented to the
hospital with high levels of PT or INR. This is a selected group of patients and a study
has not been done prospectively looking at this problem. My own read is that these
patients had liver problems, either caused by the Tylenol or accelerated by Tylenol since
Tylenol can damage the liver in large doses. Clinically, I have never been impressed with
any interaction and one would expect to see something in 20 years with all the tylenol
that my patients take. I would continue to take tylenol with coumadin until further
studies are done. Limit the dosage to 6-8 per day. If you have any history of liver
disease do not take the tylenol until further studies are done. This has received far too
much publicity without any critical analysis of the study.
Coumadin and hair loss/thinning
Question: Has there been any connection reported between Coumadin and hair
loss/thinning? If so, what can be done to prevent/counteract this?
Answer: I have never heard of it as a problem. I haven't seen it in my patients.
You might want to call the company - they might have an idea. It is Dupont: 302-992-4240.
Better, safer, natural alternatives
Questions: My wife underwent open heart surgery in November 1995. She also has a
pacemaker(second one)having had the first one implanted at a relatively young age. Since
her open heart surgery (to correct a left mitral valve prolapse, and in so doing, having
an annuloplasty performed), her cardiologist (not the surgeon) has had her on Coumadin,
and as far as we know her current INR is 3.1. There are some symptoms that would indicate
excessive Coumadin levels for her. I repeat, for her. I remark this, because in spite of
these apparent side effects, her cardiologist seems strictly focused on the attainment of
the INR number no matter what. Yet, everything that we read indicates that these symptoms
are indicative of an excessive Coumadin dosage. Her symptoms (that we are concerned could
be due to excessive Coumadin) are: 1. Even small wounds take longer than average to heal.
2. In some instances, she may have suffered a small cut or scratch, and is unaware that
she is bleeding until someone else points it out to her. 3. Recently, she has been
experiencing nausea, dizziness, and weakness. 4. Also recently, when nurses or hospital
technicians drew blood, the needle punctures caused later subcutaneous bruising or
bleeding over areas of up to 2 inches by 4 inches. As is typical of medical practice
today, most treatments are "managed by the numbers", so regardless of our
growing concerns as expressed to my wife's cardiologist, all he seems to focus on is the
INR number. It is almost as if he believes that IF her INR number is numerically correct
(although we understand that 3.1 may be somewhat too high for the AVERAGE patient and
evidently definitely too high for my wife)then, all of her health parameters will somehow
fall into place. Are there alternatives to this approach to treatment, and should not a
more integrative or holistic assessment of each specific patient be taken as a starting
point, rather than simply utilizing what (to us) appears to be an increasingly coarse and
imprecise (even clumsy and dangerous) method of treatment? Are there other newer drugs or
natural medicines that can safely accomplish the same intended results?
Answer: Sounds like you need a new doctor. Assuming that she had an artificial
valve replacement, she will need to be on coumadin for her lifetime. There is no
alternative nor herbal remedy that will be effective to prevent the possible strokes. If
she had a porcine valve, this is not the case. Nausea, dizziness, and weakness are rarely
due to the coumadin. Her other problems probably are. I would convey my concern and your
need to switch physicians unless they can be addressed. Usually, one can keep the INR
about 2.5 without major problems, but I do not know her specifics. A second opinion may be
Question: I've had three strokes, and I am a 61 yr. old male. My Dr. at Watson
Clinic in Lakeland, Fl. has prescribed coumadin, lipitor, and triamterene. He assures me
that these meds do not cause increased irritability, nervousness, or listlessness. Yet, I
am experiencing all of these problems. I have talked with other coumadin users who also
experience these problems. Are these side effects of the drug? Is another drug just as
effective? What are my options?
Answer: I doubt it is coumadin. You might try to selectively stop the lipitor
and triamterene(with your doctor's knowledge). There really is no other drug than
coumadin. Aspirin can be used but may not work. Ticlid is available but can be toxic and
Question: I was shocked to read your advice that green leafy vegetables are of no
concern to someone taking coumadin. My 73 year-old mother is taking the drug, and she was
told by several physicians to limit her intake of foods (many of them green & leafy
vegetables) that are rich in vitamin K and can reduce the drug's effectiveness.
Answer: Sorry to shock you, but I stand by my opinion. It really doesn't matter
clinically as long as the intake doesn't vary a great deal from day to day. Large intakes
followed by abstinence could cause problems. Try it and see. In theory it matters, in
Question: I have been taking Coumadin for the past eight years. I am 34 years old,
and I am concerned with the long term usage of the medication. Can you please inform me of
the long term side effects or symptoms that can be caused by Coumadin.
Answer: Don't seem to be any other than the yearly risk of bleeding-- currently
Coumadin and Migraines
Question: I have a customer that has been on Coumadin Therapy for several years and
is starting to get migraine headaches. In product information it mentions that headaches
are a possible side effect. I have not been able to find anymore information to confirm
that it is possible the coumadin is causing the effects, and the customer has lost a
number of days of work because of them. What possible change in therapy could be
instigated, or what type of treatment could I suggest to his physician?
Answer: I doubt that the coumadin is the culprit. If he were to develop
migraines due to the coumadin, I strongly suspect that they would have occurred with the
onset of therapy. The fact that he developed them several years later doesn't make any
logical sense. Secondly, I must have 200 patients on coumadin and I have never heard one
of them complain about headaches. I would focus on the other potential causes for new
headaches rather than the coumadin.
Coumadin and Alcohol
Question: My 76 year old father has been on Coumadin for about four months as a
result of blood clots in his leg(post surgery side effect). He has long enjoyed one scotch
and soda each evening before dinner. Just one and no more. His surgeon said this would be
OK with the Coumadin. His regular Doctor is saying no more than one drink per week. We are
confused. I hate to see him lose this small pleasure in life if it is not necessary.
Answer: The best way to keep coumadin from causing trouble is to keep your diet,
medications, etc. the same from day to day. Changing metabolism of coumadin is responsible
for the different levels. As a consequence, it is fairly easy to adjust coumadin for the
changes seen with alcohol metabolism if it is fairly regular. Irregular use of alcohol(or
other drugs)makes management more difficult. A regular drink is usually easier to
compensate for than an occasional drink. I'd stick to his usual regimen.
Question: I have been taking coumadin for 5 years after mechanical aorta and mitrol
valve replacement. Each month I get a blood test for pro-time. I have been told that my
readings vary between 19 and 23. Can you tell me what the safe reading ranges are and what
are the consequences for falling outside the safe region on either end.
Answer: Patients who have undergone heart valve repair or replacement are placed
on blood-thinner medications to avoid having clots form about these valves. Essentially,
these valves are foreign in the body in that they are close to, but not identical to, your
natural valves which were replaced. Thus, there is a small but still significant risk for
clot formation; thus, you have the need for blood thinners. Coumadin is the agent
typically employed for long term blood-thinning or "anticoagulation". This
medication works by inhibiting some of the chemicals in your body that are part of clot
formation. There is still a large number of other chemicals responsible for forming clots,
and therefore, patients on these medications do not have a great deal of bleeding problems
assuming that the medication concentration in the blood is not too high. Therefore, your
provider must keep your blood level high enough to avoid clot formation but not so high so
as to allow for abnormal bleeding to occur. The numbers you describe refer to the blood
test used to determine whether you have the right amount of coumadin in your system. There
is no "correct range" for this medication because its uses vary, and the desired
range of blood test levels varies, as well. You should discuss the desired ranges for your
particular needs with your health care provider. Typically, patients with mitral valve
replacements are kept with Prothrombin Times (or "PT", the numbers you reported)
in the range of 20-25, while patients with aortic valve replacements are kept in the 16-19
range. If the level is too low, the risk of clot formation goes up, while if the
"PT" is too high, the risk of bleeding complications goes up. Also keep in mind
that the results of your routine blood test is a sample measurement, and that like all
other functions in the body, monthly or even weekly variation is normal. Thus, slight
variations in your levels are to be expected, and your health care provider will continue
to monitor your levels to make sure you stay within your desired range.
Coumadin and diet
Question: I am searching for a list of foods to avoid while taking Coumadin.
Answer: It isn't a big deal about foods. I have received a lot of criticism for
this view, but I still stick to it. Green leafy vegetables do contain Vitamin K and large
amounts can potentially change your blood results. However, few people eat these amounts
and the vegetable intake is only a problem if it varies widely from day to day. In
general, these vegetables contain antioxidants that probably improve your health.
Consequently, avoiding leafy green vegetables and vegetables in general is not good
advice. Rather, ensure that your intake is relatively predictable. Vegetable orgies one
week followed by abstinence the next can potentially produce problems, but few follow this
type of regimen. Watching different food intake on coumadin is more a theoretical than a
Question: I am asking a question in regards to my father (67) who is taking
coumadin due to 3 heart attacks in one night 2 years ago. For 6 to 8 months, he has been
spitting up blood. He has his blood check any where from every 2 weeks to 4 weeks. He
started spitting up blood again, and his PT was checked and this was OK. He was sent to an
ear/nose/throat doctor who said it could possibly be his coumadin, even though his PT is
O.K. Is this serious, and could he started bleeding and not stop? He said the blood could
be coming from the back of the tongue.
Answer: There is a fine line with coumadin between risk and benefit and between
too much and too little. An inflamed or irritated area can still bleed if coumadin is
normal, but it is less likely if the coumadin is on the low end of "normal" .
What have his INR been doing and why is he on coumadin. These are the pertinent questions.
If he is on coumadin for less than dramatic reasons(concerning his heart) it might be
possible to let the coumadin drift down. The risk here is either a stroke or heart attack.
This needs to be discussed with his physician and with another member of the family
present to ensure that there is no confusion.
Coumadin and food interaction
Question: The question was asked "Specifically, which foods must he stay away
from..." This is the exact question I went on-line to have answered and it was
completely evaded. This is of great importance to me. So you can understand my
disappointment when you responded "green Leafy vegetable are of no concern".
Well, exactly what is? There is definitely a warning about consuming certain foods,
especially those high in vitamin K.
Answer: I don't tell my patients to avoid any specific food while on coumadin. I
do discuss medical interactions with other medications-- aspirin and other non-steroidal
antiinflammatories, etc. I do not limit or restrict their diet in any manner. Reference
pharmacology textbooks do reference that foods high in Vitamin K can produce a problem.
Clinically this is not seen. Almost all vegetables have Vitamin K and green leafy
vegetables the most. However, the health benefits of the antioxidants in vegetables far
outweigh any theoretical risk inherent in Vitamin K ingestion.
Question: I am just a little guy, a patient on Coumadin, 73, under a physician's
care. I have lost 100 pounds in the last year and feel great. I exercise by swimming and
my Doctor is pleased. I have a problem which does not worry him. He says it is very
common. My heart beat is not totally in rhythm. I get these short circuits and don't even
notice it, but my heart beat is not totally rhythmic. To lessen the chances of clots
forming he has prescribed Coumadin and I am monitored closely. My problem is a possible
side effect. It bothers me. It doesn't really bother my Doctor. This side effect is
perversion of taste. I just can't taste things like I used to. I ate a hamburger for the
first time in a year, and I couldn't taste it. I could have been eating anything.
Answer: I've had a lot of patients on Coumadin and never seen this side effect.
There are actually labs which can check your taste. A more common drug to cause change in
taste would be digoxin. It is sometimes given in irregular heart beats. Are you on
anything besides coumadin?
Question: I am taking coumadin daily (5 mg daily and 7.5 mg on Sundays) and
recently had Relafen prescribed by another doctor. I just read that certain
anti-inflammatory drugs don't go well with coumadin. Please advise whether I may be
running into a problem.
Answer: Coumadin is a common drug used in anti-coagulation. It really is the
only drug that is effective and simple to give. Its major drawback is its tendency to
interact with other drugs. Either by changing the liver metabolism of coumadin-affecting
the anti-coagulation level, or by affecting the ability of the blood to clot. In general,
aspirin and non-steroidals (like Relafen) should be used sparingly, if at all, with
coumadin. Coumadin affects the coagulation profile - aspiring and NSAIDS the platelet
Coumadin and Vitamin E
Question: What dosage of Vitamin E can be considered safe when taking Coumadin
Answer: There should be little interaction. However, I would keep my dosage of
Vitamin E about the same each day so any side effects can be compensated for in your
regular blood testing for coumadin.
Question: I recall being told that Coumadin was formerly used as rat poison. Is
this true? If so, where can I find more information on the history of this drug?
Answer: Coumadin (warfarin) was invented at the University of Wisconsin in 1949.
It was initially used as a mammalian pesticide since excessive anticoagulation will
produce bleeding leading to shock and death. Most current pesticides use a slightly
different chemical that has a time release characteristic rather than a one dose effect.
However, this drug has been used extensively since the early 1950's in humans for
anticoagulation. Close monitoring is required with the use of this drug to ensure that the
right dose is administered. This drug interferes with Vitamin K. Consequently, any change
in Vitamin K intake can change the dosage of coumadin. I couldn't find a history of the
animal pesticides. However, it is manufactured by Dupont: # 302-992-5000. They are usually
Question: My 86 year old aunt has been on Coumadin for the past 6 months and claims
she feels like death warmed over since shes been on this drug. Is there a special
diet she should be on? Are there any side affects with this drug? To this point she has
been a very healthy person, but for most of her life she has had heart flutter. That is
the reason the doctor put her on this drug.
Answer: Coumadin rarely causes side effects. Why is she taking the drug? I
suspect the medical condition that requires her to take the drug is the reason that she
feels so poorly. There is no logical reason that her physician would suddenly start the
drug without a change in her cardiac rhythm. I suspect that her rhythm is changed
resulting in the change in her affect.
Question: My husbands doctor just prescribed "coumadin" for him
without even doing a blood test. He is taking a low aspirin dose every day and is leery of
taking the coumadin. He is 73 and takes lanoxin and calin.
Answer: There are several reasons to take coumadin. However, these should be
discussed with the patient and the risks and benefits should be explained. There is always
a risk of bleeding with coumadin. Your husband needs to understand why he is taking this
drug and what benefit the physician expects. Usually blood tests are not done until the
patient is on the drug for a week or so. Then they should be done regularly (depending on
how much variation is seen in his test from weekly to every 2 months).
Question: My mother is currently taking Coumadin. Is there a restriction of green
vegetables while on this drug? If so, could you send me a list of the ones she should
avoid? The drug has saved her life and stopped her stroking, but she also has bowel
problems and must eat a lot of fiber.
Answer: There are a lot of medicines to avoid or to be careful taking with
coumadin, but green vegetables are not one of them.
Question: My Dad was prescribed coumadin after his by-pass surgery recently.
Specifically, which foods must he stay away from. Green, leafy vegetables is one type, but
what else? Should he stay away form Grapefruit?
Answer: Green leafy vegetables are of no concern. There are many medications
which can interact and any new medication should be discussed closely with your physician
and pharmacist to determine the effect. For practical purposes, regular monitoring will
reduce the risk of bleeding, which is about 5-10% per year.
Coumadin & Floxin
Question: Is there any interactions when taking Coumadin and Floxin which would
increase the INR level?
Answer: Coumadin(warfarin) is an anti-coagulant used in a variety of situations
to decrease the ability of the body to form clots. It acts on different
"factors" in the blood necessary to start the coagulation cascade. These factors
are made in the liver. Consequently, any drug that is metabolized in the liver can affect
the level of coumadin in the body and the subsequent INR. INR is a measure of the
decreased coagulation ability of the blood. Coumadin was initially discovered at the
University of Wisconsin as a rat poison. As you can see too much of this drug will ruin
your whole day. Therefore, it is very important that all your physicians and your
pharmacist know that you are on coumadin. In general, antibiotics must be followed
extremely closely to avoid either too much or too little coumadin. Floxin(ofloxacin)
belongs to a class of drugs called quinolones. These drugs in general increase the effect
of coumadin;that is, taking floxin will require your coumadin dose to be decreased.
However, this is a very individual effect and must be watched by more regular blood tests
to test the effect of coumadin while and immediately after taking the antibiotic.
Coumadin & Alcohol
Question: I am a 23 year old who is on Coumadin for a blood clot in my arm. I know
that alcohol can increase the effects of the drug and cause internal bleeding. Is it safe
to have a moderate amount of alcohol (2-3 drinks) once a week while on Coumadin or should
it be avoided completely?
Answer: Usually, a moderate amount will not drastically affect the PT level.
Coumadin & Glucose Level
Question: Presently my Mother's coumadin dosage has been undergoing change
(reduction). Is one's glucose level able to enhance the effect of coumadin?
Answer: Not usually.
Coumadin & Diet
Question: I have been on coumadin for 9 months now for DVT in my left lower leg
after a knee replacement. I'm on 10 mg QD. My PT level has been 19-20 without any
problems, until last week. My PT was 35.2 and My PTT was 77.1. Now my big question is,
could my poor diet and/or eating a lot of grapefruit have any thing to do with such a big
change in the levels going sky high so fast. My doctor took me off my coumadin for approx.
5 days and took a blood sample today and wants me to start again tomorrow with 5 mg.
Answer: Unless you suddenly started large doses of coumadin probably not. There
are several possible interactions between diet and coumadin; but, it usually doesn't have
a major effect like this unless there is a drastic change in your vegetable
intake(particularly leafy, green vegetables). In clinical practice, most patients don't
have these major dietary shifts. Other drug interactions are the most probably cause.
Coumadin's Side Effects
Question: Coumadine has been prescribed after I experienced a vein occlusion behind
by eye. Can Coumadine have side effects that make one feel really tired and not well?
Answer: Not usually.
Coumadin & Artificial Aortic
Question: I have an artificial aortic valve and all appears to be going OK, but
just recently my INR is going down even though my doctor continues to increase my
coumadin. Why is it going down?
Answer: Could be a lot of different reasons. Something is changing your liver
metabolism or your diet is increasing in Vitamin K. Any of several drugs could cause this.
I wouldn't spend a lot of time trying to figure it out unless it is markedly variable.
Strange Side Effects
Question: I am just a little guy, a patient on Coumadin, 73, under a physician's
care. I have lost 100 pounds in the last year and feel great. I mean great. I exercise by
swimming and my Doctor is pleased. I have a problem which does not worry him. He says it
is very common. My heart beat is not totally in rhythm. I get these short circuits and
don't even notice it but my heart beat is not totally rhythmic. To lessen the chances of
clots forming he has prescribed Coumadin and I am monitored closely. My problem is a
possible side effect. It bothers me. It doesn't really bother my Doctor. And this possible
side effect is perversion of taste. I just can't taste things like I used to. I ate a
hamburger for the first time in a year, a Burger King, and honestly I couldn't taste it. I
could have been eating anything. I buy these sugar-free Jell-O products. I can taste
Cherry and Orange and Strawberry real well. I have problems with the taste of chicken,
beef, spaghetti, sauces, etc. Somewhere I think I have read about Comedian and the
"perversion of taste". I am writing you because I am new to the Web and I have
searched and searched and I just can't find this side effect. Serious side effects are in
abundance. Perhaps this one just does not merit mentioning. I hope you can help me. I am
desperate. I am 73 and now weigh 177. I am proud of this weight loss. Please look into
this for me and give me your comments.
Answer: None of my patients report this side effect. Also, I looked too and
didn't find any reports. You might contact the manufacturer Dupont 619-457-2553.
Question: I have been experiencing atrial fibrillation (episodic every 2-3 months)
for about 5 years and since the onset have been taking Lanoxin and seeing my doctor every
6 months for level checks and general check-ups. At my last visit he surprised me by
becoming very insistent on my using Coumadin to help prevent a possible stroke. I am
questioning whether taking this drug is necessary for me. I am 51 years old and the cause
of my fibrillation has not been attributed to any heart disease. Are there alternatives
which would work for me, aspirin perhaps?
Answer: There is an increased risk of stroke if you continue to have episodic
atrial fibrillation. Coumadin will be the best drug; although, aspirin has an effect in
decreasing stroke. If you were 80, I'd recommend the aspirin; but, you have a lot of years
for a stroke to affect you. Another alternative would be to eliminate the A Fib with a
drug like amiodarone which I would try if you haven't . It is pretty clear the digoxin
isn't working. Another alternative are beta-blockers; but, they are less likely to work.
Question: My husband has been on Coumadin since September for a clotting problem.
Before that time, he was having no noticible problems, but snce has had problems with
hyperventilating, chest pains (musculatory, not cardiac), muscle spasms (from the
hyperventiting), fatigue, impotence, and many smaller side effects. We have been told that
this could not be caused by the drug (hes not on any others), but the difficulties
are more evident when his dosage is high. When he had to go off the drug for clotting
factor testing, the symptoms disappeared, and returned when he started it again. Since the
clot didnt cause these, could there be other factors that may have? Hes in his
late 30s, not overweight, but seems to bis n the physical health of one in his
fifties with lO0 extra pounds. Would there be anyone doing research on Coumadin who has
seen or witnessed any of the above side effects? Where could I find further studies on
this drug that would clarify why this could be happening?
Answer: Coumadin, as you know, is a form of blood thinner, in that
it affects blood clotting function, making the patient less likely to form abnormal clots.
The uses of this medication are many, ranging from clots in the leg veins or lung,
abnormal heart rhythm, to genetic/inborn clotting problems. Close follow up to check blood
levels of the medication is essential to avoid the most common side effect- that of
bleeding from high coumadin levels in the blood. Your husbands symptoms definitely
warrant further investigation. As you mentioned, he is not taking any other medications,
and there appeared to be a relationship between his being off the medication and symptom
improvement. It may be that there truly is a relationship, but one instance of symptom
improvement with one instance of drug removal may not necessarily be grounds to assume a
cause and effect relationship. That is to say, perhaps there are other reasons for why
there appeared to be a time related relationship when the drug was stopped, but the
symptom improvement was not due to removal of the drug itself. The Physicians Desk
Reference lists as rare side effects of coumadin (in addition to bleeding with high
levels) nausea, rash, diarrhea, and possibly priapism (persistent and painful penile
erection). Although there is always the possibility that the medication is indeed causing
your husbands symptoms, given the side effects listed for coumadin, further
investigation into other causes for the symptoms should be pursued. A visit to your health
care provider, even if it means repeating the symptom complex to him or her, may be
beneficial. Persistence of symptoms over time may provide additional insight for your
provider into what some of the possible causes are.
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