INR

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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

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

 

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?