coumadin and multivitimins and hemolysis

[thecman321]

Anyone out there know about multivitimins? Most of the ones i have seen contain some vitimin K. Is this enough to throw off INR.

Also, anyone know anythng about mechanical heart valves and anemias? Anyone out there experience anything like that? I have read that mechanical valves have a hemolytic (red blood cell destructive) properties. Has anyone had issues with this?
My wife who had AVR in January has been feeeling fatigued lately and all seems normal otherwise. She sees her cardio next week. How about Iron supplements?


thanks for any input

 

[Nancy]

Joe takes Coumadin and also takes vitamins. I found a cheap brand that has no vitamin K.

Joe also had hemolysis. He has ProCrit shots three times a week to help with it. He also takes folic acid (prescription strength) and iron pills. He is under the care of a Hematologist. Even with all this, his blood is rarely normal. Without all the help, he WILL slip back into severe anemia which would require transfusions.

Hemolysis can be very, very sneaky. Make sure that your wife's doctors do a total hematologic workup for her. It took a lot of investigation to make the determination that Joe's chronic anemia was indeed hemolysis.

He's had it for quite a while. Now he has a secondary situation which is a combination of hemolysis, his congestive heart failure and splenomegaly (enlargement of the spleen). This has caused anemia and low platelet count. He'll be seeing his hematologist in a couple of weeks.

Just make sure that your wife is not carrying any additional fluid on board. Make sure her doctors check out her abdomen for ascites. And ask for a hematologist to follow her.

In Joe's case, I believe that most of the hemolysis is from his 28 year old mechanical valve which is much larger and has dfferent hemodynamics than the newer sleeker models. He has two mechanicals, the old aortic and a newer St. Jude mitral.

 

[MarkU]

My cardiologist has me take Centrum Silver, primarily because it has a lower Vitamin K content than regular Centrum (not just because I'm gettin old...)
But it's the same old story, I have to be consistent and take it every day to help keep my INR stable. I've gotten in the habit of taking both my Coumadin and Centrum together at the same time everyday.
Mark

 

[Guest]

I see a lot of people who get their INR elevated because they run out of Centrum Silver and decide to wait until they go to the grocery or pharmacy in "a few days" to get more.

Some valves may cause hemolysis because they "chop up" the red blood cells. Hemolysis is fairly easy to check for. When blood is drawn from the vein, it is put into a centrifuge and spun until the cells and plasma are separated. If there is hemolysis, the plasma will have a red tint to it, not the clear yellow that it normally is.

 

[thecman321]

thanks Al

thanks Al

is hemolysis looked for during routine INR?
Can you have hemolysis in a very mild subacute form which would cause fatigue?
Would not having enough vitimins in your diet cause fatigue?

 

[Guest]

Whether or not hemolysys is looked for depends on the method used. I do fingersticks using whole blood so everything is red and we do not look for it. I also know how to do the lab test using blood that is spun down. Only the plasma is used in testing the INR in this method. I know that hemolysys is supposed to be noted and that some tests will be invalid if there is a lot. Somebody that knows more lab technicalities than me on the site should answer in a few days.

Fatigue usually comes from having way less than normal amounts of red blood cells, so I doubt that any hemolysis that was small would be enough to make any difference.

Vitamins (but not herbals) fall under the jurisdiction of the FDA. The FDA requires that there be truth in the advertising. You will notice that no ad for a vitamin ever says that it will overcome fatigue because no study has proven this. In many places, vitamins are sold because of what sales clerks tell you. They may make this claim but there is nothing other than legend to back it up.

If you take warfarin, then you know how powerful legends can be.

 

[ccrawford]

If you regularly take a vitamin with vit K, then you will need to increase your dosage of Coumadin, but that is not a big deal as long as you consistently take the vitamin. I choose to take a vitamin without vit k, but Its getting harder to find. I used to take one a day but they "improved" it by adding vit K so I switched to the CVS house brand but it too got "improved" so I again switched to one a day for women which does not have vit K. Why the mens do and the womens doesn't ??? Wish they would quit improving things !

 

[Bionic Valve Tim]

I gave up trying to find a multi without vit-K and I just take the Safeway generic version of Centrum. I keep plenty on hand. Incidentally, I also keep a box of "slim fast" meal replacement bars around, since they have a good chunk of vitamin K, too. If my INR is a tad high or if I forget to take my vitamin, I'll eat one of those.

Post-op I was found to be anemic and the hemotologist guesssed that hemolysis had a role in the anemia, but wasn't solely responsible. He gave me a prescription for folic acid and told me to take B6 and one other OTC vitamin (sorry, my brain just quit on me!). I have to admit that now I only take the folic acid, and even that I take less frequently than described. I go back for a followup next month so I guess I'll see what the lab says.

As far as I know, he made this diagnosis without testing for hemolysis. In fact, I didn't realize you *could* test for it, so I'm going to ask about that when I go in

BTW cman, glad that your wife is doing well other than the fatigue!

Tim

 

[Blanche]

Tim:
Vitamin B6, Folic Acid, and Vitamin B12 are often taken together. These were prescribed for my husband when he was fatigued after an illness.
Perhaps B12 is what your doc suggested.
Blanche

 

[geebee]

I take either One-A-Day Essential or Medicine Shoppe Essential formula. Neither has Vit. K. They are also a small size, good for me since swallowing those horse pills is a problem. However, they are vitamins only - no minerals.

 

[Bionic Valve Tim]

Perhaps B12 is what your doc suggested.
Blanche

<smacks forehead> That's the one

Tim

 

[thecman321]

great vitimin advice

great vitimin advice

Anyone know the milligrams/ quantity of the daily reccomended or suggested folic acid, B6 and B-12??

thanks

 

[Lon]

I am new here the end of this month will be my 3 year anniversary. I take liquid vitamins and minerals; I took them before my surgery, after I asked my cardiologist if I could keep taking them. They have K in them he looked at the ingredients an said if they make me feel better to take them. We adjusted my coumadin accordingly. I am on 10mg a day and have no problem keeping stable.

 

[Cris N]

I take multivitamin with no Vit K (Walgreens). After I had some blood work done my PCP wanted me on Iron supplements. The one I take is called SLOW FE and causes the least amount of stomach & bowel difficulties.

 

[Wendy0716]

Multi vitamin without VIt-K

Multi vitamin without VIt-K

I also take a multi vitamin without Vit-K made by GNC, I have been taking it for awhile and have had not problems with my INR. I am on 15mg of coumadin and have not had to change my dose at all since I have been taking the GNC multi vitamin.