Vitamin K and Coumadin – What you need to Know.

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Article by Laura Earl, RN, BSN, CACP

If you have been diagnosed with a blood clot, a medication named warfarin (Coumadin) may be prescribed as part of your treatment to prevent further blood clots. You may need to take warfarin (Coumadin) for a few weeks, months, or the rest of your life. While taking warfarin (Coumadin), there are a few things about vitamin K you will need to know.

What is vitamin K?

Vitamin K is a naturally occurring vitamin.  Vitamin K is primarily found in leafy green vegetables such as spinach, broccoli, and lettuce, and enters your body when you eat these foods. Vitamin K is produced by the bacteria in your intestines, and it is also in vitamin and nutritional supplements. Your body uses vitamin K to produce some of the clotting factors that helps blood clot.

How does Warfarin (Coumadin) work?

Warfarin (Coumadin) works by interfering with how your body uses vitamin K.  The metabolism of warfarin (Coumadin), vitamin K, and vitamin K dependent clotting factors takes place in your liver.   Warfarin (Coumadin) prevents the production of vitamin K dependent clotting factors.  As a result, clotting occurs at a much slower rate.  One good way to think about vitamin K and its importance while taking warfarin (Coumadin) is that you need to maintain a balance between the amount of vitamin K in your body and the amount of warfarin (Coumadin) prescribed by your healthcare provider.

What do I need to know about Vitamin K, if I am taking warfarin (Coumadin)?

Changes in the amount of vitamin K in the diet can alter the metabolism of warfarin (Coumadin ®).  However, vitamin K does not influence the action of other blood thinners, such as heparin or low molecular weight heparins (Lovenox ®. Fragmin ®, or Innohep ®).

You should aim to keep the amount of vitamin K in your diet consistent.  For example, if you normally eat two servings per day of food that is high in vitamin K content, you should continue this pattern every day.  If you do not normally eat foods that are high in vitamin K, do not suddenly eat a large amount of them.

There are certain things about vitamin K that you cannot control.  For instance, some medications and illnesses (intestinal diseases and/or infections) can lower the amount of vitamin K in your body or change how your liver metabolizes your warfarin.

Can vitamin K affect my INR?

Yes, your INR refers to the international normalized ratio test, a standardized way to measure how your blood is clotting.  The lower your INR, the more quickly the blood clots or the “thicker” the blood.  The higher your INR, the longer it takes the blood to clot or the “thinner” the blood, putting you at risk for bleeding problems.  With an increase in vitamin K , your INR level may drop.  Conversely, a decrease in vitamin K intake may increase the INR.  Other things, like medications, antibiotics, and herbal products may also influence your INR.

What should I tell my anticoagulation healthcare provider?

Any time your vitamin K intake changes, it is important to notify your anticoagulation healthcare provider.  Some of the circumstances that may apply include if you:

  • Start taking a multiple vitamin or other vitamin supplement that contains vitamin K (such as Viactiv ®).
  • Use a nutritional supplement such as Boost ®, Ensure ®, Glucerna ® or SlimFast ® – shakes or nutritional bars.
  • Increase or decrease the amount of leafy green vegetables you are eating (refer to the USDA website at http://www.nal.usda.gov/fnic/foodcomp/Data/Other/pt104.pdf)
  • Start or stop drinking V8 ® juice.
  • Develop an illness, including a respiratory infection or gastrointestinal flu that changes how well you are eating. Have lifestyle changes or emotional stress such as illness, the death of a family member, travel, or even seemingly simple things like moving or remodeling your home

You do not have to avoid foods or other products that are high in vitamin K; these foods have many other vitamins and minerals that are part of a healthy diet.  The most important thing to remember about vitamin K intake is being consistent as much as possible and communicating any changes that may occur to your anticoagulation healthcare provider.

Disclaimer

The National Blood Clot Alliance (NBCA) and its Medical and Scientific Advisory Board (MASAB) do not endorse or recommend any commercial products, processes, or services. The views and opinions of authors expressed on the NBCA or MASAB websites or in NBCA or MASAB written materials do not necessarily state or reflect those of NBCA or MASAB, and they may not be used for advertising or product endorsement purposes.

It is not the intention of NBCA or MASAB to provide specific medical advice, but rather to provide users with information to better understand their health and their diagnosed disorders. Specific medical advice will not be provided and both NBCA and MASAB urge you to consult with a qualified physician for diagnosis and for answers to your personal questions.

Posted November 24, 2008

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7 Responses to "Vitamin K and Coumadin – What you need to Know."

  1. Georgia Huenefeld Posted on January 22, 2014 at 12:54 am

    Has any alternative physician or group come up with an anti-bloodclot diet that works without prescription drugs? I’m on warfarin and wonder if I could learn how to balance my diet and skip the anti-coagulant.

    • Vicki Posted on March 24, 2014 at 3:11 am

      You don’t know me or how much I want off this stuff as well – however, I know the only thing that could possibly end this atrial fib is an ablation, and I don’t think I’m ready for that yet.

      • Andy Posted on April 23, 2014 at 5:22 pm

        Vicki,

        Over 12 years ago, was diagnosed mild hypertension 140 over 90 and was given a beta blocker, Metoprolol. Within a month, I began having afib attacks, Mild at first, progressing to severe to the point I landed up in hospital several times. I was put on Coumadin but within 2 weeks, my INR spiked so high the doc took me off of it.

        The afib attacks continued and got worse and worse. Many times, it was so bad I thought I would die. So bad all I could do is squat on the bed and rock back and forth till the attack passed some 4 to 6 hours later. It took 2 years to get to that point. I would get 2 to 3 attacks a week. Thinking it was stress, I quit my job. That didn’t help.

        Doing research on the Net, I came across some references that beta-blockers can provoke arrhythmias in some people. I took that info to my doc but he insisted there was no connection.

        Nevertheless, I weaned myself off the Met over a period of 2 weeks and the result was that my afib attacks stopped and I was free of them for 5 weeks. This from 2 to 3 per week before, on the Met. Horrified, my Doc insisted that I go back on the Met. I took ONE dose and within a few minutes, I got an afib attack. And, from there, despite not taking any Met anymore, the attacks resumed.

        More research led to a study by the Mayo Clinic that magnesium had an anti-arrhythmia function. So I began taking Magnesium supplements and increased the daily dose from 250 milligrams to 2000 milligrams, in divided doses. That was my upper limit as any higher and it gave me the runs.

        At the same time, I avoided the triggers of an attack. I ate half as much, twice as often, smaller meals, NEVER stuffed myself. NO alcohol. NO spicy food. I began wearing track pants full time, no pressure of a belt across the stomach.

        Within three months, the attacks stopped and I was free from them for 5 years. More on that later.

        Here is how I think was going on. If you cut out a piece of heart tissue, it would pulse at some 80 beats per minute. That’s automatic, that’s what keeps you alive when in a coma. That is the first heart rate control. When your heart needs to beat faster, as when you exercise or your fight or flight response is triggered, your body produces adrenalin and that raises your heart rate. When you stop the exercise, your vagus nerve goes to work to lower your heart rate to normal.

        These three mechanisms work together in balance.

        Metoprolol, a beta-blocker, interferes with the normal, adrenal function. This imbalance can provoke arrhythmias in some people.

        I spoke of all of this with a local gastroenterologist and I posited this theory. MY attacks were a result of stomach stimulation, feedback through the vagus nerve, back to the heart. The vagus nerve is a master nerve of sorts that has branches from the brain, through the spine to all organ systems, including the stomach and the heart. The gastroenterologist agreed with me that I was on to something, My regular Doc also, finally agreed that I was right.

        For 5 years, I kept a modest, maintenance dose of 250 milligrams of magnesium per day and had no problems.

        However.

        One summer I took up berry picking. By then I was wearing normal pants with a belt. After 4 consecutive days of berry picking, I had my first afib attack in 5 years. The belt pressing against my gut was the trigger. From there, I started to have regular attacks again.

        So the gut theory proved out. And once again, my strategy for stopping the attacks worked, only it took longer, the second time around.

        So, this might be something for you to consider. Just start taking 250 milligrams of magnesium, the citrate version is most effective, that is, magnesium citrate. Avoid all triggers related to the stomach. You know,, for me, a strong cough or sneeze or even a “belly” laugh would sometimes provoke an attack. Again, the stomach is involved. OR AT LEAST IT WAS FOR ME. But even so, the literature refers to post-prandial (after eating), the Valsalva maneuver that can either provoke an attack or stop one. Often, I found that if an attack was starting, if I tightened my gut and held on, the attack would sometimes abort.

        Do some research on the Net with the above in mind. Spend an hour a day. Ask Google, phrasing the questions differently. Read, read, read and save articles that may offer you some insight into what I am saying.

        I too was headed for ablation or even the maze procedure. This is open heart surgery, they put criss cross cuts on your heart and the scar tissue stops the erratic signals from doing their nasty. It works, apparently, but a few dollars worth of magnesium and attention to triggers worked for me without the risk and expense of surgery.

        Telling your doctor about this is up to you. In my experience, some react negatively and some are intrigued and have an open mind.

        Good luck, I truly hope it works for you.

        • Ray Posted on May 14, 2014 at 5:09 pm

          Andy
          You have really done your homework, just wondering if you could take a minute and see if you think my thinking is on the right track…
          Up till 1 year ago, never had any health issues, then all of a sudden couldnt breathe , thought I had pneumonia
          Was admitted to hospital for a week,
          Was put on coumadin, lasix, spironolactone digoxin, ( later took me off digoxin) one thing i have is And always have been is chronic constipation, have to take miralax with prune juice every day. I think that this is what caused my afib, constant straining…
          My afib has stopped, but i want to stop taking all the other meds,too..any comments?

  2. […] Vitamin K and Blood Thinners – What You Need to Know (article via NBCA) […]

  3. Gayle Posted on March 25, 2014 at 3:35 pm

    I have a question, I’m in bed most of the time. I have failed back syndrome surgery, and my pain is so excruciating, I just stay in bed w/o exercise. I also have Osteoprosis and semi acute fractures different places in my body. I’m taking vit. K2 w/other vit.s w/D3 and calcium and magnesium. Is this combo of vit.s helping so I don’t get clots, while helping my brittle bones?

    Please help me, I’m very mis – informed…… Thank you and may God bless you.
    Sincerely,
    Gayle

  4. Rachel Posted on April 23, 2014 at 9:46 am

    im on warfarine for life and i have got factor five lien.Being on warfarine for a long time Wil it cause my any harm .

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