Coumadin/warfarin and probiotics

[sharon]

I started taking Envive every other day about 4 weeks ago. My INR went from 3.0 a month ago to 1.8 today. Nothing else in my diet has changed. I have read that the probiotics can produce Vitamin K. Anyone else have similar problems after using probiotics?
Sharon Feldman
St Judes AVR April 1997

 

[pellicle]

Personally I can't imagine why probiotics could have any effect. However my INR went from 2.6 on the 24th to 1.9 on the 28th. I began aware of this on the 28th because I was discussing a similar finding that @leadville discovered in his own one checking so I thought why not check mine and see (because I do stuff like that).

I was quite surprised (as was he) and began monitoring to discover this:

24th INR =2.6
28th INR =1.9 (this means a drop in the order of 0.2INR per day)
29th INR = 2.1 (and now a rise)

So I decided to conduct this as an experiment of "let's look and see what happens if I didn't know and just went with my weekly measurements.I t is the 30th here now as I write this and I intend to check again tomorrow to see where it's going to.

I have zero reasons that I can point to to explain this (and @leadville was similarly perplexed), except to say that

• this sort of thing seems to happen
• this underscores again why I always support and encourage weekly testing

If I didn't test weekly then who knows where this would have gone without intervention? It may have corrected back up, or it may not have.

In your case I would most certainly recommend increase your dose to put INR where it should be? To advise more I'd need to know your normal dose.

do you test weekly? Do you self test?

 

[vitdoc]

The gut biom (bacteria) is known to be involved with the production of Vit K. So at least theoretically altering the biom with pro biotics or other things such as antibiotics might affect endogenous Vit K. And the effect of warfarin.

 

[pellicle]

The gut biom (bacteria) is known to be involved with the production of Vit K.

that's a good point, but for some reason I thought this was very small in humans, but it bears investigating. Also I had the view that probiotics never get passed the digestive acids to get into that area, I've never seen research confirming it does.
https://www.nccih.nih.gov/health/probiotics-what-you-need-to-know
myself however I just eat natural non sugared, non flavoured plain yoghurt. Its on the same shelves as the other stuff. I always recommend you look at the labels for how much sugar is in the other 'dairy based goo' sold as "Yoghurt"

Best Wishes

 

[sharon]

Hi Pellicie and Vitdoc,
Thanks for answering. Have been checking probiotics out more carefully and have also come across more info that it could help produce vitamin K. I decided to stop taking the probiotics. I do not have a home tester. My cardiologists office did testing until recently but now the hospital pharmacist is doing the tests instead. I do have an appointment in a week to check again. In the meantime I will just take it easy with my greens for a couple of days. When I had my valve replaced (it will be 25 years in April), home testing hadn’t started. The machines became available a bit later. I bought one and it was a real pain to use! Plus my insurance wouldn’t cover the machine or the testing stuff. I would have to prick my finger and get 2 or more drops of blood into this little cup. If you didn’t get the blood in right it would cause a bubble and the machine couldn’t use it - so had to find some more blood in a different finger. Can’t remember the name of the company that made it. I used it for 3 years, but gave up and went back to getting my INR done at the lab. A year or so later my cardiologist got the INR machine in the office and life was good again. Unless my INR is really off I usually don’t change my dosage - I like to control it by eating less greens. I am on 5 mg 6x and 2 1/2 1x a week.