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cpt278

Does anyone have a site for herbal (or alternatives ) that interact with coumadin.
I would like to take apple cider vinegar.

Thanks Cpt278








AVR/AAR 11/05
 
Vinegar is essentially a weak solution of acetic acid. It can contain a variety of other compounds depending upon the process of preparation. Some of these compounds have been noted to be salicylates, aspirin like substances, and can therefore have pharmacological activity. Many of these other compounds tend to be removed during distillation processes so that much of the bottled commercial vinegars are missing these things. In order to assure the presence of the phytocomponents it has been suggested that one procures a vinegar that is cloudy and has pariculate matter. This is where, they say, the most important substances lie.

Salicylates happen to increase the effectiveness of warfarin in an indirect way. That is because they have an effect on platelet adhesiveness. This results in reduced blood clotting action. Warfarin works in another way. It interferes with the formation of several important clotting factors that are made in the liver. Any impact from the vinegar would be an enhanced state of anticoagulation and might result in a higher risk of bleeding.

There is also a direct effect at slowing down clotting of blood that is observed when vinegar is added to a test tube sample. It might also play a role in vivo. This has to do with the acidic nature and the coagulation process.

Warfarin is actually fairly easily managed though. It is simple enough to measure and watch the protime and INR and make various adjustments. The impact on warfarin by other agents is also easily managed as changes that might occur do not happen quickly. There usually is plenty of time to compensate provided that there is adequate medical management. Such a check up is important to do whenever there is any change in the status of a host of variables. It appears to me at this point that your husband is quite stable and well managed meaning that should any problem be suspected it could be quickly handled without incident.

The ingestion of vinegar raises another possibility. That is the acidification and resultant destruction of GI bacteria. These normal organisms are responsible for adequate vitamin K production which is in turn crucial for the synthesis of clotting factors. If this were to be happening it would also (more directly) cause the warfarin to be more effective. Maybe even requiring a lowering of the dose. But again this would be readily apparent and easily managed.

For now at least I can tell you that there are no known significant interactions between vinegar and warfarin nor are there any warnings to regard the potential.

I am not aware of any reports of vinegar causing the reverse situation. That of increasing blood clotting. However I am open to investigate the information that you have read and invite you to share that with me. It might open up some more discussion.

Bear in mind finally that your husband is ingesting a relatively small amount of vinegar each day so that the outcome will be slight to non-existent that there will be any clinically significant effects. If you ever discover indications of abnormal bleeding or if his patterns or routines change it might be worthwhile to have another protime drawn. I doubt there is much to be concerned about here but I still welcome your further information.

http://en.allexperts.com/q/Pharmacy-1407/Coumadin-vinegar.htm
 

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