Questions about Vit K

[meanrenee]

Hi everyone,

As many of you know Frank got his new valve last week. He is recovering very well, thank God. I was wondering if you can educate us about foods other than the obvious leafy greens as to the vit K content.Things we may not be aware of. I was very suprised to see mayo on the high list. He loves sushi and I wonder about the seaweed. I have ordered Al's book but not sure if it covers foods to beware of.His level has been good so far but we are early into this and I know as he gets back to a regular routine it will probably flucuate. Thanks , Renee

 

[Ross]

Right now, the Coumadin link is down, but there is a .pdf file we have on the main page and I believe Nancy or Blanche have additional links too.

General rule of thumb--If it's dark green, it's high in Vit K! Go easy on the seaweed.

Here is the .pdf link

http://www.valvereplacement.com/downloads/VitaminK.pdf

 

[Nancy]

Also BEWARE of Ensure, Boost, nutritional food bars like Luna bars, any nutritional supplements such as Slim-Fast (most of its product has Vitamin K), and any other type of nutritional supplement which you stir into milk or comes in a bar. Read the labels. V-8 juice has it and doesn't list it, many multiple vitamins have it. Be careful with herbal things. Al has some of those listed.

Some of the things mentioned above have whopping amounts of vitamin K in them, and many hospitals regularly push them on patients without regard for those on Coumadin. It's lack of knowledge on their part.

Al has a food list on his website.

 

[Nancy]

Also forgot that soy products can affect your INR. Al has that info on his website also.

 

[Ross]

http://www.trekfit.com/nc/nf_05_K.html

One courtesy of Blanche!

 

[meanrenee]

Thanks for the links and info. I am finding out that maybe this coumadin won't be so bad after all ! We have been lucky so far as his INR was in range on our first post hospital test. He is having another draw next wednesday, one week from the last one. Does that sound right ? I was expecting more frequent testing but maybe since he was in range it is not needed. I try not to think about it too much but when he got a BAD headache I kind of freaked. Worried about a brain bleed. I read somewhere either here or on als site about a woman that had that happen. Maybe too much info is not good either ?. Thanks guys, you are making this so much easier for both of us. Renee

 

[Ross]

Until things are stable, testing every one to two weeks is the norm. Anything sooner then this is usually a waste of time and money. The only exception to the rule here that I can think of is if you would start an antibiotic like Biaxin etc. The reason here is because it will cause a rapid INR rise while it's being used.

It takes at least 3 days for a dosage change to show in the test, so half a week is gone right there. I've read and seen some people have been tested every 3 days, dosage changed again and that isn't going to accomplish anything.

Once he's in range and stable, they'll stretch testing out to 2 and 4 weeks then just once a month, though I don't feel comfortable with just once a month testing.

With this stuff, you need all the correct information you can get, good or bad, because there are far too many professionals out here that do not know how to manage Coumadin or the patient. You really do have to be your own advocate a lot of the time.

When it comes to the veggies, eat what you like and adjust the Coumadin around the diet. The only thing you have to do is be consistent in the amounts of Vit K taken in daily. If your close and don't do any binging, you shouldn't have many problems.

 

[NC-Cutie]

Coumadin

Coumadin

Hi, As you know I am almost 6 weeks post op Mitral Valve Replacement. I am on Coumadin. My first INR after I came home was normal 3.0 I had another one drawn a week later and to everyones surprise, it had gone to 7.9.(Too thin) They stopped it for three days and I had it drawn again. Well, it had dropped to 1.3(Too Thick) I went to the Doctor the next day and it was checked again and had dropped to 1.2 Now I am having it drawn twice a week (Mon and Thurs) and each time I am getting different results. My surgeon said that when the Coumadin seems to be hard to regulate you need to be monitored more closely than normal. At 1.2/1.3 I knew (being in the medical field) that I was at stroke level and it worried me to the point of being afraid to go to sleep. I have had patients stroke out in their sleep because of their blood being too thick. I know that being in the medical field I have an advantage over those who have no medical knowledge, but trust me on this, keep your INR monitored closely. You can get a range difference in 2-3 days. I am at the point now that I am almost afraid to eat anything because it's hard to tell what will trigger my level. I know the foods that we give our patients who are on Coumadin, but it's different when it's You.

 

[Guest]

It is OK to test more often than once per week but you need to make dosage adjustments based on how much you had over the past 7 days. Of the thousands of e-mails I've had through my website probably 1/3 of them have been complaints about wildly fluctuating INRs "in spite of gettine tested every 3 days".

It takes about 3 days to see the effects of the last dosage change. So, if the next dosage changes is based on the last one and not over the past 7 days you have about as much chance of getting the correct warfarin dose as a puppy does of catching its tail.

Judging from the complaints, there are many people dosing warfarin who have never grasped this fact.

 

[SJJ]

I'm certainly way too new at being a coumadin user to be qualified to comment, not that it's seeming to stop me, but I think some of the folks who've had lots of experience will come along soon to tell you these sudden and dramatic shifts in dosage are not going to help you get stabilized. If they verify my hunch, you might want to consider another source for getting your dosages managed. If they don't, write my comments off as the rantings of a recent OHS patient.
Sue

 

[SJJ]

I see Al posted while I was composing my reply. Listen to him, he be the man.
Sue

 

[Nancy]

NC-Cutie-

It is not just what you eat that causes fluctuations in INR. It's is also your activity level. Right after surgery, you are almost immobile. And as your activity level becomes more normal, your INR will start to drop.

Al Lodwick is the "man" with all the knowledge about Coumadin, he's so right about testing every 3 days. It's useless.

Joe has been on Coumadin for 26 years. And when he had wild fluctuations, it was because his doctor (at the time) didn't have a clue and would continually over-correct and then test him every few days. It was insanity. He has someone now who knows what he's doing. Maybe now while you're still in early recovery mode, 7 days will be about right, but you also have to have someone monitoring you who makes careful and steady adjustments in your dosage and who has a good grip on the idiocyncrasies of Coumadin. Lots of doctors get so frightened about out of range levels, that they make too big an adjustment.

You are not drinking Boost or Ensure or other nutritional supplements or eating nutritional bars are you?-- They have enormous levels of Vitamin K in them. Hospitals always push these things on neophyte Coumadin patients because they do not know about the Vitamin K. But it's right on the can. Read all the labels. Be careful of soy products, and V-8 juice has Vitamin K and doesn't list it. Some people also have mentioned that pineapple juice affects their INR.

 

[NC-Cutie]

I guess being a nurse has me constantly in "Nurse Mode" We test our patients in the hospital everyday who are on Coumadin or any blood thinner. So, I guess I just have seen the importance of testing often. When you've seen patients die from strokes because their blood clotted, or patients being admitted with INR's less than 2.0 and seeing the problems they have, I am just a little more cautious. Not that I think anyone is right or wrong, I have just seen a little too much of it

 

[Ross]

Nessie don't take this the wrong way, but do you know how Coumadin works? I mean how it's metabolized in the body, it's half life etc.

I'm appalled to this moment that Doctors have to write the prescription for this stuff and most of them have no clue on how to regulate dosing a patient. It makes their high priced educations appear rather tainted.

 

[Nancy]

You are the perfect candidate for home testing. Tried to convince Joe to go that route, but he likes his lab venous draws. Doesn't even want the fingerstick stuff. It's the BIG time poke for him. Go figure! Maybe he's a vampire. LOL.

 

[Guest]

Testing often is not wrong. It is making dosage adjustments based on the last dose, not over the past 7 days. Then the dose should be adjusted up or down by 10 to 15%. Any more is illustrating that the person monitoring warfarin does not understand it.

NC-cutie - for example - an average person's INR will decrease by
half over 48 hours. Your INR was 7.9 - after 48 hours it can be predicted that it would be about 2.0. Another 24 hours and it should have declined by another 0.5. Your result was 1.3. Almost exactly what should have happened. My guess is that you were tested on a Thursday and the doctor didn't want to mess with lab values and warfarin doses over the weekend, hence the three day hold. Either that or the doc didn't stop to figure out what would be predicted. You will find that most of the people on this site would rather have a slightly high INR rather than a low one. It is much easier to stop bleeding than to install a new valve or treat a stroke.

I order INRs on my hospitalized patients every day, too. For the first 3 to 5 days, they are meaningless but the docs all like to look at the levels and the test only costs the hospital about $10. I also keep a chart showing how much warfarin they have had so that I can base doses on the past 7 days.

I have done 20,000 (maybe 25,000) warfarin tests, so I know my way works. I'm home recovering from my own (non-heart) surgery but the docs are calling me anyhow for advice.

 

[meanrenee]

Okay, this may be a stupid question, But what is the INR on a person not taking coumadin ? 0 ? Just curious.

 

[Ross]

The normal range of the INR is 0.9-1.2.

They got these figures from a group of known healthy people, averaged the outcomes, then listed the low and the high.

 

[NC-Cutie]

A normal INR for people not on Coumadin is 0.0 - 1.5. When you have a mechanical prosthetic heart valve the target range is between 2.5 and 3.5. Your doctor may set different ranges depending on individual situations. My range is 2.5 - 3.0

 

[NC-Cutie]

Can someone tell me how to get all of the information posted at the end of my post. You guys have your surgery dates, hospitals and doctors at the end of each post and reply. Do you put it there after each post or is there a way to make it automatically appear?