The use of vitamin K to reduce high INR

The use of vitamin K in patients with warfarin over-anticoagulation lowers excessively elevated INR faster than withholding warfarin alone; however, it has not been clearly demonstrated that vitamin K treatment does, in fact, lower the risk of major hemorrhage. As vitamin K administration via the intravenous route may be complicated by anaphylactoid reactions, and via the subcutaneous route by cutaneous reactions, oral administration is preferred. A dose of 1-2.5mg of oral phytomenadione (vitamin K(1)), reduces the range of INR from 5.0-9.0 to 2.0-5.0 within 24-48 hours, and for an INR >10.0, a dose of 5mg may be more appropriate.

Source: The use of vitamin K in patients on anticoagulant therapy: a practical guide – PubMed

Mycoplasma (and bacteria in general) as a Cause of Narrowing of the Cardiovascular Valves

Cause of Cardiovascular Calcification

Research shows a connection between the level of valve calcification and the presence of mycoplasma pneumoniae and chlamydia pneumoniae in the affected tissue. The study speculates that the calcification is not an age-related degenerative phenomenon, but rather a reaction to the presence of bacteria.

Culture-negative Endocarditis: Mycoplasma hominis Infection

Presence of mycoplasma and viruses in damaged heart tissue and arteries (but also in normal tissue)

Bacteria in Calcific Aortic Valve Stenosis

Can Plant-Based Diets Lower the Risk of Cardiovascular Disease?

A research article published in Plos One in2018 looks at results of multiple observational studies focused on one or more cardio-metabolic risk factors in vegans and omnivorous diets. Macro-nutrient intake and cardio-metabolic risk factors were compared by dietary pattern. People on vegan diets and others on omnivorous diets were compared for energy, saturated fats, body mass index, lipoprotein cholesterol, triglycerides, glucose levels, blood pressure. The results support the idea that plant-based diets are likely to lower the risk of cardiovascular disease and diabetes.

Source: Cardiometabolic Risk Factors in Vegans; a meta-analysis of observational studies

Can Red Yeast Rice be Used to Lower Cholesterol?

An article published by the Penn State Hershey Medical Center looks at red yeast rice (RYR or Went yeast), its use for lowering cholesterol, and the need for further research. RYR acts similarly to statins, particularly monacolin K (Lovastatin). It is not yet determined whether RYR lowers cholesterol because of its statin-like properties or other properties. Studies conducted on RYR support the fact that RYR lowers LDL (“bad”) cholesterol levels. Red yeast (Monascus purpureus) stops the action of an enzyme in the body that helps make cholesterol.  One of the proprietary products most often studied was Cholestin, which contained monacolin. However, current Cholestin products do not contain RYR. Asia, and Chinese communities, use powdered RYR as a food coloring for fish, alcoholic beverages, and cheese. RYR supplements should not be taken by people under 20yrs but for adults, the dosage depends on the formula. Most studies have used 600 mg, 2 to 4 times daily. There are precautions, side effects, and interactions relating to RYR that need to be considered.

Source: Complementary and Alternative Medicine Penn State Hershey Medical Center – Red Yeast Rice

 

Is it Safe to Take CoQ10 While Taking Warfarin or Plavix (clopidogrel)?

Question: Does CoQ10 interact with blood thinners? Answer: There are studies with conflicting results on whether CoQ10 may interfere with warfarin treatment or decrease the effectiveness of warfarin (Coumadin). There are studies that suggest that CoQ10 may increase the risk of bleeding when on warfarin and other studies that suggest CoQ10 may decrease the risk of bleeding when on warfarin. Other studies indicate that there is no effect so long as your INR (bleeding time) is stable. It’s not clear whether CoQ10 affects Plavix treatment. Consult with your doctor before taking any supplement or medication.

Source: ConsumerLab Q&A

Use of K₂ and Warfarin During Perioperative Period of Catheter Ablation

A study published in the Journal of Pharmaceutical Health Care in 2016 conducted population pharmacokinetic/pharmacodynamic modeling for retrospective clinical data to investigate the effect of vitamin K2on the anticoagulant activity of warfarin in the perioperative period of catheter ablation. 579 INR values of prothrombin time from 100 patients were analyzed using the nonlinear mixed-effects modeling program NONMEM. A 1-compartment model was adapted to the pharmacokinetics of warfarin and vitamin K2, and the indirect response model was used to investigate the relationship between plasma concentration and the pharmacodynamic response of warfarin and vitamin K2.

The population parameters obtained successfully explained the observed INR values and indicated an increase in sensitivity to warfarin in patients with reduced renal function. Vitamin K2 administration of more than 20 mg caused a slight dose-dependent decrease in INR on the day of catheter ablation and a delayed INR elevation after warfarin re-initiation. A pharmacokinetic/pharmacodynamic model was successfully built to explain the retrospective INR data during catheter ablation.

Source: Effect of vitamin K2 on the anticoagulant activity of warfarin during the perioperative period of catheter ablation: Population analysis of retrospective clinical data

Could Coenzyme Q10 be Used as a Supplement for PD Patients?

A paper by Robert Alan Bonakdar, MD, and Erminia Guarneri MD, published by aafp.org in 2005 looks at coenzyme Q10 and its use in the treatment of a variety of disorders including PD, plus cardiac, immunologic, and oncologic conditions. Coenzyme Q10 appears to be a safe supplement with minimal side effects and low drug interaction potential. As yet, coenzyme Q10 has not been approved for the treatment of specific diseases in the USA. A randomized, double-blind, placebo-controlled, multicenter study of 80 patients found that 1,200 mg per day of coenzyme Q10 was associated with up to 44 percent less functional decline in patients with Parkinson’s disease, including activities of daily living. A study of 28 patients with Parkinson’s disease also demonstrated mild symptom improvement with daily oral dosing of 360 mg of coenzyme Q10. These results are awaiting confirmation.

Source: Coenzyme Q10 – American Family Physician

Vitamin K, as a Treatment, and its Interaction with Warfarin

An article published in U.S.Pharmacist in 2012 looks at the emerging role of K2. Recent research has found that vitamin K could be used to treat osteoporosis, cardiovascular diseases, and perhaps Alzheimer’s, skin aging, and various cancers. Vitamin K plays a role in regulating the healthy function of calcium and preventing pathologic calcification of the vessels and soft tissues. Vitamin K vitamers include K1 phytonadione; K2 menaquinone, and K3 menadione. The ability to convert vitamin K1 to K2 varies widely between species and breeds of animals. Vitamins K1 and K2 chemically share a common ring-structured nucleus but possess different types of side chains. Humans require dietary preformed vitamin K2 for optimal health, due to its superiority over K1 and for normal clotting of blood. The bones, liver, cartilage, and arterial walls can pull vitamin K from the blood. The current FDA recommendation is for the liver requirement only. Vitamin K antagonists include Warfarin, the blood-thinning drug that inhibits vitamin K-dependent clotting factors. Vitamin K can decrease the blood-thinning effects of warfarin and lower PT or INR value.

Source: The Emerging Role of Vitamin K2

 

What you Should Know About your Diet and Warfarin

The blood-thinning medication, warfarin decreases the chance of harmful blood clots by blocking the effects of vitamin K which helps blood-clotting proteins form in the liver. Your warfarin dose is determined by your PT or INR measurements that show how long it takes for your blood to form clots.

A document published by ImpactTeam looks at how your diet affects warfarin and how the amount of vitamin K in your diet will determine the warfarin dose needed to prevent bleeding. Warfarin may have possible interaction with cranberry juice, mango juice, grapefruit juice, caffeine, charbroiled foods, alcohol, garlic, soy, ginger, and green tea. In addition, there is potential interaction of dietary supplements with warfarin.

Source: Warfarin and your Diet

 

How Does Fasting Affect INR and %TTR?

A report published in the Journal of Thrombosis and Haemostasis looked at the effects of fasting in Muslim patients taking warfarin. The anticoagulation medication warfarin is influenced by changes in the diet and fasting might influence the INR and the %TTR. During the month of Ramadan, when Muslims fast during daylight hours (about 13.5hrs/24), stable warfarinised Muslim patients had their INR level tested before, during, and after Ramadan. Unsurprisingly the INR measurement and %TTR changed. The study concluded that fasting significantly increases the mean INR of medically stable patients taking warfarin and the likelihood of having an INR above therapeutic targets.

Source: The effects of fasting in Muslim patients taking warfarin

 

What are the Benefits, Side Effects, and Uses of Resveratrol?

A study published in the MDPI journal Biomedicines in 2018 looked at the pros and cons of Resveratrol. Resveratrol has a wide range of beneficial properties; it is cardioprotective, an antioxidant, neuroprotective, has anti-cancer activities, and anti-inflammatory properties. However, its hydrophobic nature gives it limited bioavailability resulting from its poor water solubility. Resveratrol has not been found to have any side effects but this may depend on the dosage. Resveratrol can effectively­­­­ help with a number of conditions. Its neuroprotective properties can help with various neurogenerative conditions such as Alzheimer’s, Huntington’s, and PD. Although Resveratrol’s benefits are well documented some studies have shown that it may behave as a pro-oxidizing agent, thus it may also have implications in the pathology of several diseases.

Source: Resveratrol: A Double-Edged Sword in Health Benefits

Can you Take Fish Oil or Krill Oil Supplements with Warfarin Without Significantly Affect  the INR~

A study published in the MDPI journal Nutrients looks at the use of fish oil with warfarin and whether it significantly affects the INR or incidence of adverse events in patients. Warfarin is an anticoagulant often used to manage atrial fibrillation and deep vein thrombosis. However, patients have to be careful about drug interaction with warfarin. Fish and krill oil products are among the many complimentary medicines which have been flagged as having a potential interaction with warfarin. This study assesses the influence of fish and krill oil supplements on warfarin and looks at patients that took warfarin simultaneously with fish or krill oil. The result was that overall, the oils did not significantly alter the efficacy of warfarin.

Source: The Use of Fish Oil with Warfarin Does Not Significantly Affect either the International Normalised Ratio or Incidence of Adverse Events in Patients with Atrial Fibrillation and Deep Vein Thrombosis: A Retrospective Study

Ginseng May Modestly Reduce INR in Patients Taking Warfarin

A study published in Pharmacy Times looks at whether ginseng affects warfarin response. In one study Ginseng was associated with a modest reduction in both the INR and the warfarin area under the plasma concentration- time curve. It seems likely that the effect on warfarin could result in adverse outcomes in at least some patients who receive the combination. In one case, a 47-year-old man who had been stabilized on warfarin with an INR of about 3 had a reduction in his INR to about 1.5 after he took ginseng for 2 weeks. In another case of a possible reduction in warfarin effect with ginseng, thrombosis occurred in a prosthetic aortic valve. These results are consistent with the idea that ginseng may reduce the effect of warfarin. In conclusion, to reduce the likelihood of an adverse drug interaction between warfarin and ginseng, patients on warfarin should avoid taking ginseng products or be advised not to switch from one brand to another or vary the dose of ginseng. If a patient changes his ginseng intake any change in the anticoagulant effect of warfarin should be monitored.

Source: Does Ginseng Affect Warfarin Response?

 

Use of Anticoagulants After VHD Valve Repair

A 2015 article published by the American College of Cardiology looks at Anticoagulation for Valvular Heart Disease. Surgical repair of VHD with either a mechanical or bioprosthetic valve is a common solution. Thrombotic and embolic complications and anticoagulation-related bleeding are by far the most prevalent contributors to morbidity and mortality after surgery for VHD. Furthermore, the presence of atrial fibrillation, also requires lifelong anticoagulation in the majority of patients. This article looks at the recommendations for use of anticoagulation after valve repair with a mechanical device. Subsequent studies have shown the addition of aspirin to VKA therapy in patients with mechanical valves leads to reduction in risk of thromboembolism and mortality. For bioprosthetic valve replacement the optimal antithrombotic regime is less clear. The article includes recommendations for antithrombotic therapy in patients with bioprosthetic heart valves. Recommendations from the ACC/AHA largely leave the choice of antithrombotic regimen in the setting of bioprosthetic valve replacement up to individual clinicians. Investigators have yet to establish the role for non-VKA oral anticoagulants (NOACs) in the setting of bioprosthetic valve replacement. however, a growing body of literature suggests better safety profiles of the NOACs in head-to-head trials against warfarin for non-valvular atrial fibrillation.

Source: Anticoagulation for Valvular Heart Disease – American College of Cardiology

Review: The Role of Dietary Fat in Treatment of Brain Diseases

A review published in the Current Neuropharmacology journal in 2018 looked at the impact of dietary fats on brain function. It also examined gut-brain communication through microbiota; the impact of probiotics and prebiotics on brain functions; SCFA’s, microbiota, and neuroinflammation. It reviewed lipid sensing, satiety, and processing of hedonic food; the impact of diet on the hypo-thalamic control of reproduction; neuroprotective effects of N-3 PUFAs; dietary PUFAs, brain PUFAs and the role of PUFAs. The results of this review revealed that dietary fats are both friends and foes for brain functions. However, dietary manipulation for the treatment of brain disorders is not just a promise for the future, but a reality. In fact, the clinical relevance of the manipulation of dietary lipids, as for KDs, is well-known and currently in use for the treatment of brain diseases.

Source: Impact of Dietary Fats on Brain Functions
LGIT safe (see 305)

Whole Food Plant-Based Nutrition and Cardiovascular Disease

A review by Caldwell B. Esselstyn published in the Journal of Geriatric Cardiology in 2017 covered the connection between a plant-based diet and coronary artery disease. Caldwell states that in ignoring diet as a cause of CVD there is no hope for a cure as patients continue to consume the foods that destroy them. He discusses studies conducted using WFPBN in patients ill with CAD. The results showed that WFPBN can halt and reverse CVD. In summary, current palliative cardiovascular medicine consisting of drugs, stents, and bypass surgery cannot cure or halt the vascular disease epidemic and is financially unsustainable. WFPB can restore the ability of endothelial cells to produce nitric oxide, which can halt and reverse disease without morbidity, mortality, or added expense.

Source: A plant-based diet and coronary artery disease: a mandate for effective therapy – Coldwell

Suporting Articles:

Diet for Heart Health

A study by Caldwell published by the NIH set out to show that plant-based nutrition helps prevent coronary artery disease in a large group of patients. 198 patients with CVD were followed and given counseling on how to convert from a regular diet to plant-based nutrition. Results showed that 89% adhered to the diet and in the group of adherent participants major cardiac events recurred at a rate of 0.6%. This was significantly less than reported in other similar studies where a smaller group was used. Of the non-adherent participants, 62% experienced adverse events. Caldwell concludes that patients with CVD respond to intense counseling and when on a sustained plant-based diet for a mean 3.7 years they experience a low rate of cardiac events. Plant-based nutrition has the potential for a large effect on the CVD epidemic.

Source: A Way to Reverse CAD?

Supporting Articles: Evidence listed by Coldwell to support a low-fat vegan diet: