G
Guest
There is a new case study that was announced on-line today about a woman whose fluctuating INRs were traced to starting and stopping fish oil.
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L
LA_Cruiser
allodwick, is this a fish story..........
allodwick, is this a fish story..........
....or it it for real?
allodwick, is this a fish story..........
....or it it for real?
G
Guest
Fish oil story as opposed to snake oil story.
LUVMyBirman
Well-known member
Hi Al,
How about Flaxseed oil? Any comments on this product?
My GP would like to see me start it " try to naturally" lower my cholesterol. Then, in almost the same breath she said "sometimes it elevates the cholesterol further"
So tell me, why would I want to mess around with it? First concern is INR!
Thanks
How about Flaxseed oil? Any comments on this product?
My GP would like to see me start it " try to naturally" lower my cholesterol. Then, in almost the same breath she said "sometimes it elevates the cholesterol further"
So tell me, why would I want to mess around with it? First concern is INR!
Thanks
G
Guest
I don't know about flaxseed oil. You could be a study with the number of subjects equal to 1 (n=1) for us.
I am the supervisor for what is called the Clinical Pharmacy Support Services. This includes a lipid management clinic. We get almost the same results as taking a statin by advising people on how to avoid saturated fats and walking at least 10,000 steps per day at least 5 days per week.
I have also posted the fish oil case report at http://www.warfarinfo.com/fishoil.htm
I am the supervisor for what is called the Clinical Pharmacy Support Services. This includes a lipid management clinic. We get almost the same results as taking a statin by advising people on how to avoid saturated fats and walking at least 10,000 steps per day at least 5 days per week.
I have also posted the fish oil case report at http://www.warfarinfo.com/fishoil.htm
LUVMyBirman
Well-known member
Thank you Al. Wish my issue was induced from fats and or saturated fats. Do not consume much of either.
If I decide to start the Flaxseed....will post my findings.
If I decide to start the Flaxseed....will post my findings.
J
JimChicago
Thanks for that info on cholesterol Al. How many minutes walking is 10,000 steps? I have a doctor who is big on the statins but I've heard they have bad side effects. I'd much rather take a natural - diet - exercise route like the one you spoke of.
On Flaxseed oil - this chart says it can increase INR:
http://www.rxfiles.ca/acrobat/cht-herbal-di.pdf
This site says flaxseed oil decreases platelet aggregation - probably a good idea to test frequently when starting taking it:
From:
http://www.drugstore.com/qxa1775_333181_sespider-does_flaxseed_oil_interact_with_other_therapies.htm
>>>>
Flaxseed oil contains essential fatty acids (EFAs), which may offer some benefit in lowering cholesterol, decreasing platelet aggregation, insulin resistance, reducing inflammation, and relieving pain. Limited studies in humans and animals have suggested that flaxseed may reduce the risk of certain types of cancers, including breast cancer. However, more study is needed to determine whether flaxseed is helpful in cancer prevention.
>>>>
On fish oil and coagulation:
From:
http://lpi.oregonstate.edu/infocenter/othernuts/omega3fa/
>>>>>
Anticoagulant medications: Patients taking fish oil or marine-derived omega-3 fatty acid supplements in combination with anticoagulant drugs, including aspirin, copidogrel (Plavix), dalteparin (Fragmin), dipyridamole (Persantine), enoxaparin (Lovenox), heparin, ticlopidine (Ticlid), and warfarin (Coumadin) should have their coagulation status monitored using an assay of prothrombin time (PT) that has been standardized using the International Normalized Ratio (INR) (118). One small study found that 3 g/day or 6 g/day of fish oil did not affect PT/INR values in 10 patients on warfarin over a 4-week period (119).
119. Bender NK, Kraynak MA, Chiquette E, Linn WD, Clark GM, Bussey HI. Effects of Marine Fish Oils on the Anticoagulation Status of Patients Receiving Chronic Warfarin Therapy. J Thromb Thrombolysis. 1998;5(3):257-261. (PubMed)
>>>>>
From:
http://www.health-marketplace.com/Omega-3.htm
>>>>>
Caution:
EPA and DHA have been shown to inhibit abnormal clotting within blood vessels (thrombosis). Most ischemic heart attacks and strokes are caused by abnormal arterial blood clots, so consuming these fatty acids may help protect against these types of cardiovascular diseases. However, those taking anti-coagulant drugs like Coumadin (warfarin) should inform their doctor that they are taking EPA or DHA supplements. The physician may want to adjust the dose of anticoagulant medication based on blood tests that measure coagulation factors such as prothrombin (PT). Since EPA and DHA interfere with blood clotting, those who suffer from any type of hemorrhagic disease related to excessive bleeding or blood vessel leakage should consult their physician
>>>>>
From:
http://www.lef.org/protocols/prtcl-155zz.shtml
>>>>
Thrombosis Prevention
Update: 6/18/03
Changes made to: Combining Coumadin with Antiplatelet Agents
As has been previously described, Coumadin interferes with specific coagulation factors that can induce a thrombotic event. Coumadin is classified as an "anticoagulant" agent.
Aspirin, fish oil, vitamin E, and garlic inhibit platelet adhesion and platelet aggregation and are classified as "antiplatelet" agents. The inhibition of blood platelets' ability to adhere and/or aggregate also decreases the likelihood of thrombosis.
In a perfect world, an individualized program would be designed to deliver the optimal combination of anticoagulation and antiplatelet agents to provide the broadest protection against thrombosis without inducing hemorrhage.
There is much debate and confusion about the interactions between dietary nutrients and prescription antithrombotic medications regarding clot formation. The concern expressed in some studies involves potential interactions between Coumadin and antiplatelet agents such as ginkgo biloba, green tea, vitamin E, garlic, and fish oil (Heck et al. 2000). There has been apprehension that certain supplements put the patient at risk for bleeding problems by adding to the overall effects of Coumadin.
As a result of this concern, some doctors advise patients who are taking Coumadin to avoid any dietary supplement that could possibly cause increased bleeding. A problem with this ultracautious approach is that it deprives the patient of nutrients they may need to sustain life. It also prevents the use of antiplatelet agents that act on hemostatic mechanisms, separate from those of Coumadin, to reduce more effectively the risk of thrombosis. There are major medical publications that confirm the importance of lowering the incidence of cerebrovascular stroke and heart attack by such a two-pronged approach using an agent with antiplatelet activity, for example, Coumadin (Fasey et al. 2002; Hurlen et al. 2002).
A patient taking Coumadin has to be concerned that any food, drug, nutrient, or other substance they put into their body may not only increase the bleeding time, but also affect Coumadin metabolism, which may either increase or decrease the effect of Coumadin on the INR. The inherent variability that occurs in each individual taking Coumadin makes it difficult to provide general guidance. For instance, the underlying medical condition determines the degree of desired anticoagulation. No studies have correlated optimal anticoagulant doses of Coumadin, as measured by the INR reference range, with optimal doses of multiple antiplatelet agents, as measured by the template bleeding time (TBT).
The template bleeding time is done in a physician's office where a template device nicks the skin and the number of minutes it takes for blood flow to stop is assessed by a nurse or lab technician. The "normal" template bleeding time is up to 9 minutes. A bleeding time (BT) of 4-5 minutes might indicate increased thrombotic risk, although a BT over 9 minutes may indicate an increased hemorrhagic risk. However, what is really important in this setting is the patient context, as discussed below.
As it relates to antiplatelet agents like fish oil and garlic, a BT of 4-5 minutes could suggest a benefit of taking higher amounts of these agents, whereas a BT over 9 minutes in a patient already on an antiplatelet agent might indicate that antiplatelet agent doses are having a biological effect and further dose increases should be avoided. The problem patients face today is that there are no standards that document the ideal balance between Coumadin and antiplatelet agents such as fish oil, garlic, vitamin E, etc. Too much Coumadin and/or antiplatelet agents can cause hemorrhage, whereas too little Coumadin and/or antiplatelet agent(s) can cause thrombosis. In this setting or context, as with many medical issues, balance is the key concept. The approach that the meticulous physician uses to achieve this balance is called "titration." There is an art to titrating doses to where the "happy medium" is reached. This is embraced in the key medical concept of therapeutic index which relates to the equation:
TI (Therapeutic Index) = Therapeutic Benefits ÷
Side-Effects of Therapy.
In an ideal setting, a physician would carefully monitor the INR and the TBT to measure precisely the optimal level of anticoagulant and antiplatelet agents, respectively, in an individual patient. For instance, a patient with a heart valve replacement may have a desired INR range of 2.5-3.0, while an optimal template bleeding time may be between 7-9 minutes. If these tests were routinely conducted, a more scientific determination of the ideal intake of Coumadin, fish oil, garlic, vitamin E, etc. could be made.
>>>>
http://www.rxfiles.ca/acrobat/cht-herbal-di.pdf
From:
http://lpi.oregonstate.edu/infocenter/othernuts/omega3fa/
>>>>>
Anticoagulant medications: Patients taking fish oil or marine-derived omega-3 fatty acid supplements in combination with anticoagulant drugs, including aspirin, copidogrel (Plavix), dalteparin (Fragmin), dipyridamole (Persantine), enoxaparin (Lovenox), heparin, ticlopidine (Ticlid), and warfarin (Coumadin) should have their coagulation status monitored using an assay of prothrombin time (PT) that has been standardized using the International Normalized Ratio (INR) (118). One small study found that 3 g/day or 6 g/day of fish oil did not affect PT/INR values in 10 patients on warfarin over a 4-week period (119).
119. Bender NK, Kraynak MA, Chiquette E, Linn WD, Clark GM, Bussey HI. Effects of Marine Fish Oils on the Anticoagulation Status of Patients Receiving Chronic Warfarin Therapy. J Thromb Thrombolysis. 1998;5(3):257-261. (PubMed)
>>>>>
From:
http://www.drugstore.com/qxa1775_333181_sespider-does_flaxseed_oil_interact_with_other_therapies.htm
>>>>
Flaxseed oil contains essential fatty acids (EFAs), which may offer some benefit in lowering cholesterol, decreasing platelet aggregation, insulin resistance, reducing inflammation, and relieving pain. Limited studies in humans and animals have suggested that flaxseed may reduce the risk of certain types of cancers, including breast cancer. However, more study is needed to determine whether flaxseed is helpful in cancer prevention.
>>>>
On Flaxseed oil - this chart says it can increase INR:
http://www.rxfiles.ca/acrobat/cht-herbal-di.pdf
This site says flaxseed oil decreases platelet aggregation - probably a good idea to test frequently when starting taking it:
From:
http://www.drugstore.com/qxa1775_333181_sespider-does_flaxseed_oil_interact_with_other_therapies.htm
>>>>
Flaxseed oil contains essential fatty acids (EFAs), which may offer some benefit in lowering cholesterol, decreasing platelet aggregation, insulin resistance, reducing inflammation, and relieving pain. Limited studies in humans and animals have suggested that flaxseed may reduce the risk of certain types of cancers, including breast cancer. However, more study is needed to determine whether flaxseed is helpful in cancer prevention.
>>>>
On fish oil and coagulation:
From:
http://lpi.oregonstate.edu/infocenter/othernuts/omega3fa/
>>>>>
Anticoagulant medications: Patients taking fish oil or marine-derived omega-3 fatty acid supplements in combination with anticoagulant drugs, including aspirin, copidogrel (Plavix), dalteparin (Fragmin), dipyridamole (Persantine), enoxaparin (Lovenox), heparin, ticlopidine (Ticlid), and warfarin (Coumadin) should have their coagulation status monitored using an assay of prothrombin time (PT) that has been standardized using the International Normalized Ratio (INR) (118). One small study found that 3 g/day or 6 g/day of fish oil did not affect PT/INR values in 10 patients on warfarin over a 4-week period (119).
119. Bender NK, Kraynak MA, Chiquette E, Linn WD, Clark GM, Bussey HI. Effects of Marine Fish Oils on the Anticoagulation Status of Patients Receiving Chronic Warfarin Therapy. J Thromb Thrombolysis. 1998;5(3):257-261. (PubMed)
>>>>>
From:
http://www.health-marketplace.com/Omega-3.htm
>>>>>
Caution:
EPA and DHA have been shown to inhibit abnormal clotting within blood vessels (thrombosis). Most ischemic heart attacks and strokes are caused by abnormal arterial blood clots, so consuming these fatty acids may help protect against these types of cardiovascular diseases. However, those taking anti-coagulant drugs like Coumadin (warfarin) should inform their doctor that they are taking EPA or DHA supplements. The physician may want to adjust the dose of anticoagulant medication based on blood tests that measure coagulation factors such as prothrombin (PT). Since EPA and DHA interfere with blood clotting, those who suffer from any type of hemorrhagic disease related to excessive bleeding or blood vessel leakage should consult their physician
>>>>>
From:
http://www.lef.org/protocols/prtcl-155zz.shtml
>>>>
Thrombosis Prevention
Update: 6/18/03
Changes made to: Combining Coumadin with Antiplatelet Agents
As has been previously described, Coumadin interferes with specific coagulation factors that can induce a thrombotic event. Coumadin is classified as an "anticoagulant" agent.
Aspirin, fish oil, vitamin E, and garlic inhibit platelet adhesion and platelet aggregation and are classified as "antiplatelet" agents. The inhibition of blood platelets' ability to adhere and/or aggregate also decreases the likelihood of thrombosis.
In a perfect world, an individualized program would be designed to deliver the optimal combination of anticoagulation and antiplatelet agents to provide the broadest protection against thrombosis without inducing hemorrhage.
There is much debate and confusion about the interactions between dietary nutrients and prescription antithrombotic medications regarding clot formation. The concern expressed in some studies involves potential interactions between Coumadin and antiplatelet agents such as ginkgo biloba, green tea, vitamin E, garlic, and fish oil (Heck et al. 2000). There has been apprehension that certain supplements put the patient at risk for bleeding problems by adding to the overall effects of Coumadin.
As a result of this concern, some doctors advise patients who are taking Coumadin to avoid any dietary supplement that could possibly cause increased bleeding. A problem with this ultracautious approach is that it deprives the patient of nutrients they may need to sustain life. It also prevents the use of antiplatelet agents that act on hemostatic mechanisms, separate from those of Coumadin, to reduce more effectively the risk of thrombosis. There are major medical publications that confirm the importance of lowering the incidence of cerebrovascular stroke and heart attack by such a two-pronged approach using an agent with antiplatelet activity, for example, Coumadin (Fasey et al. 2002; Hurlen et al. 2002).
A patient taking Coumadin has to be concerned that any food, drug, nutrient, or other substance they put into their body may not only increase the bleeding time, but also affect Coumadin metabolism, which may either increase or decrease the effect of Coumadin on the INR. The inherent variability that occurs in each individual taking Coumadin makes it difficult to provide general guidance. For instance, the underlying medical condition determines the degree of desired anticoagulation. No studies have correlated optimal anticoagulant doses of Coumadin, as measured by the INR reference range, with optimal doses of multiple antiplatelet agents, as measured by the template bleeding time (TBT).
The template bleeding time is done in a physician's office where a template device nicks the skin and the number of minutes it takes for blood flow to stop is assessed by a nurse or lab technician. The "normal" template bleeding time is up to 9 minutes. A bleeding time (BT) of 4-5 minutes might indicate increased thrombotic risk, although a BT over 9 minutes may indicate an increased hemorrhagic risk. However, what is really important in this setting is the patient context, as discussed below.
As it relates to antiplatelet agents like fish oil and garlic, a BT of 4-5 minutes could suggest a benefit of taking higher amounts of these agents, whereas a BT over 9 minutes in a patient already on an antiplatelet agent might indicate that antiplatelet agent doses are having a biological effect and further dose increases should be avoided. The problem patients face today is that there are no standards that document the ideal balance between Coumadin and antiplatelet agents such as fish oil, garlic, vitamin E, etc. Too much Coumadin and/or antiplatelet agents can cause hemorrhage, whereas too little Coumadin and/or antiplatelet agent(s) can cause thrombosis. In this setting or context, as with many medical issues, balance is the key concept. The approach that the meticulous physician uses to achieve this balance is called "titration." There is an art to titrating doses to where the "happy medium" is reached. This is embraced in the key medical concept of therapeutic index which relates to the equation:
TI (Therapeutic Index) = Therapeutic Benefits ÷
Side-Effects of Therapy.
In an ideal setting, a physician would carefully monitor the INR and the TBT to measure precisely the optimal level of anticoagulant and antiplatelet agents, respectively, in an individual patient. For instance, a patient with a heart valve replacement may have a desired INR range of 2.5-3.0, while an optimal template bleeding time may be between 7-9 minutes. If these tests were routinely conducted, a more scientific determination of the ideal intake of Coumadin, fish oil, garlic, vitamin E, etc. could be made.
>>>>
http://www.rxfiles.ca/acrobat/cht-herbal-di.pdf
From:
http://lpi.oregonstate.edu/infocenter/othernuts/omega3fa/
>>>>>
Anticoagulant medications: Patients taking fish oil or marine-derived omega-3 fatty acid supplements in combination with anticoagulant drugs, including aspirin, copidogrel (Plavix), dalteparin (Fragmin), dipyridamole (Persantine), enoxaparin (Lovenox), heparin, ticlopidine (Ticlid), and warfarin (Coumadin) should have their coagulation status monitored using an assay of prothrombin time (PT) that has been standardized using the International Normalized Ratio (INR) (118). One small study found that 3 g/day or 6 g/day of fish oil did not affect PT/INR values in 10 patients on warfarin over a 4-week period (119).
119. Bender NK, Kraynak MA, Chiquette E, Linn WD, Clark GM, Bussey HI. Effects of Marine Fish Oils on the Anticoagulation Status of Patients Receiving Chronic Warfarin Therapy. J Thromb Thrombolysis. 1998;5(3):257-261. (PubMed)
>>>>>
From:
http://www.drugstore.com/qxa1775_333181_sespider-does_flaxseed_oil_interact_with_other_therapies.htm
>>>>
Flaxseed oil contains essential fatty acids (EFAs), which may offer some benefit in lowering cholesterol, decreasing platelet aggregation, insulin resistance, reducing inflammation, and relieving pain. Limited studies in humans and animals have suggested that flaxseed may reduce the risk of certain types of cancers, including breast cancer. However, more study is needed to determine whether flaxseed is helpful in cancer prevention.
>>>>
LUVMyBirman
Well-known member
Hi Jim,
Thank you very much for the information on the flaxseed! Taking a look at the link and will investigate further.
Would rather have an higher INR than a lower and adjust down. Tend to catch my levels very quickly as I am a weekly tester.
Thanks again.
Thank you very much for the information on the flaxseed! Taking a look at the link and will investigate further.
Would rather have an higher INR than a lower and adjust down. Tend to catch my levels very quickly as I am a weekly tester.
Thanks again.
G
Guest
Jim,
Thanks for all of that information. I had forgotten about the information from Elaine Chiquette and Hernry Bussey about fish oil not affecting warfarin. I have tried to concentrate on things that affect warfarin and haven't added many thiungs that do not affect warfarin. But I should include that on the page now that I have written one.
Thanks for all of that information. I had forgotten about the information from Elaine Chiquette and Hernry Bussey about fish oil not affecting warfarin. I have tried to concentrate on things that affect warfarin and haven't added many thiungs that do not affect warfarin. But I should include that on the page now that I have written one.
