Reaction time of Vitamin K

[jarno1973]

Dear Friends,

For the first time my INR is getting a bit high. Not extreme but I am thinking of increasing my Vitamin K intake a bit to come back nicely into range. I want to control this with additional home tests but am not sure when and how often to test.

Warfarin itself takes up to 7 days to take full effect. How does the vit. K react?

Hope that the experts can be a bit of help.

regards,

Jarno

 

[Protimenow]

I've found that, personally, Vitamin K can drop my INR in hours. It acts quite quickly.

How high is your INR? A few greens would probably bring it down pretty quickly. You really don't want to start the INR roller coaster by adjusting your warfarin dose, and then modulating it with K if it's too high.

The mantra at this forum is to be consistent....diet, dose, some even say to be consistently active (or inactive). It also may help to take a low dose K - I get 30 mcg in my daily vitamin packet. This helps to stabilize the INR.

Again -- Vitamin K acts pretty quickly -- they even use it in emergency rooms to reverse INRs that are dangerously high (from what I've read, I believe that this is so).

 

[jarno1973]

I've found that, personally, Vitamin K can drop my INR in hours. It acts quite quickly.

How high is your INR? A few greens would probably bring it down pretty quickly. You really don't want to start the INR roller coaster by adjusting your warfarin dose, and then modulating it with K if it's too high.

The mantra at this forum is to be consistent....diet, dose, some even say to be consistently active (or inactive). It also may help to take a low dose K - I get 30 mcg in my daily vitamin packet. This helps to stabilize the INR.

Again -- Vitamin K acts pretty quickly -- they even use it in emergency rooms to reverse INRs that are dangerously high (from what I've read, I believe that this is so).

Thanks for your reply. Consistency can be difficult for me as I travel quite a bit. If the vitamin K. reacts faster than the warfarin it seems to me that it could be very well be used to counter act when I have a temporary spike.

I am doing lots of self tests to learn about my response to warfarin etc. It would be great to know that having, e.g. 3 bottles of green tea will bring my INR down with a few tenths within a certain time. With that kind of information managing INR would become very easy.

regards,

Jarno

 

[Protimenow]

Sure, travel could make it more difficult to control your INR.
Products like Boost or Enable (I think this is what they're called) are food supplements with a lot of Vitamin K. You may also consider taking along some low dose Vitamin K pills (30 mcg might be enough).

Although Ive been an advocate of frequent testing, I still test only weekly -- unless I get a really strange result and want to see if my dosage correction helps.

A lot of people on this forum have noted that when their INRs are high, they eat extra greens. I guess that some green tea could also help lower the INR.

(If your INR isn't too high above range -- say, in the 4-4.5 range -- it may not be worth correcting immediately. Some meters overstate the higher INRs - it's a function of the meter - so your 4.5 may actually be closer to 4.0 or 4.1 -- still higher than range, but not dangerously high if you're a bit careful.

It's also, unfortunately, not a situation where you can accurately predict that if your INR is at a certain number, a green tea or vitamin K will bring it down by a specific value, or how long that change will take. INR measurement is still a rather unpredictable task - there's not a lot of science to it (not reproducible, unfortuately), meters and labs don't often agree (and neither will two labs taking blood within minutes of each other, in many cases), so we can only go for ranges.

Personally, I'd be a bit more comfortable if my meter reading was a bit high than if it was a bit low. I've learned that, for my body at least, the InRatio INRs have ALWAYS been somewhat higher than the lab values (but not predictably so).


(When I had a 1.1 and a 1.4, I increased my warfarin dose and tested every day -- and was back in range quickly. Other than a situation like this, I don't think you really need to test all that often -- of course, if you're adding Vitamin K to the mix, it wouldn't hurt to check the results within 12-24 hours)

 

[lance]

Hello Jarno
You would be helped if you posted what your INR range is and how your test results have been trending. What was your most recent test result and when was it taken?
A change in a warfarin dose will take effect in 3-4 days--not seven. So help us help you and respond to the questions I have posted. It's difficult to do so without this basic information.
Also read the "stickies" at the top of the opening page if you haven't done so already. There is a wealth of accurate information there.

 

[jarno1973]

Hello Jarno
You would be helped if you posted what your INR range is and how your test results have been trending. What was your most recent test result and when was it taken?
A change in a warfarin dose will take effect in 3-4 days--not seven. So help us help you and respond to the questions I have posted. It's difficult to do so without this basic information.
Also read the "stickies" at the top of the opening page if you haven't done so already. There is a wealth of accurate information there.

Hi Lance,

Thanks for your answer. My range is 2-3 and so far I have not been much out of range. Just recently only a 3.1 and I expected it to increase more after that. In cases like this I would like to have the opportunity to adjust with a bit of vitamin K boost instead of changing my warfarin intake because these up and downs are most likely because of my inconsistent food intake, travel and activity levels. Even though a change of warfarin takes effect in 3-4 days my experience is that it takes longer to take full effect and level out. My approach to INR management may be a bit different from most people but I am trying to find the best way to manage INR with my kind of lifestyle.

 

[Lynlw]

Hi Lance,

Thanks for your answer. My range is 2-3 and so far I have not been much out of range. Just recently only a 3.1 and I expected it to increase more after that. In cases like this I would like to have the opportunity to adjust with a bit of vitamin K boost instead of changing my warfarin intake because these up and downs are most likely because of my inconsistent food intake, travel and activity levels. Even though a change of warfarin takes effect in 3-4 days my experience is that it takes longer to take full effect and level out. My approach to INR management may be a bit different from most people but I am trying to find the best way to manage INR with my kind of lifestyle.

With a 3.1 I would not do anything different, it is so small above, it is well with in the margin of error that chances are if you had repeated the test it would have been in range. Now if you are trending up each week id keep an eye on it to see if adjustments needed to be made, but most people would be perfectly happy wifh those results and would not mess with things

 

[Protimenow]

I fully agree with Lyn -- if it's only a 3.1, and your range is 2.0 - 3.0, I wouldn't change a thing. (Some of us, myself included, have a 2.5-3.5 range and would be HAPPY with a 3.1. Even if you don't have to be in this range, have a 3.1 is of minimal risk to your health. Lots of us are living with INRs in that range).

Personally, I don't do much unless my reported INR is considerably higher than it should be. My tester seems to trend higher than actual - so a 3.9 or 4.0 wouldn't bother me (because it probably STILL means that I'm under 3.5). Only if it spikes real high, or drops low (a bigger fear for me), will I make minor changes.

At 3.1, if I were you, I would do what Lyn says -- NOTHING.

 

[Bill B]

Vitamin K can rapidly reverse warfarin, but to do so it must be given in rather large doses, something like 1 to 2 gm (1,000 to 2,000 mg). Note the usual daily intake of vitmain K is 100 mcg or 0.1 mg. Even doses of 1 to 2 gm of vitmain K takes a day or so to reverse warfarin. It takes time for the vitamin K dependent clotting factors to be synthesized. So, in cases of significant bleeding, to reverse warfain more rapidly, fresh frozen plasma (containing clotting factors) is used.

Small doses of vitmain K, less than 100 mcg, do almost nothing, at least short term to affect INR. Most green, leafy vegatables, other than kale, spinach, collard greens and mustard greens, do not have large amounts of vitmain k and would not have any dramatic effect in less than a week.

I've been experimenting personally with Romaine lettuce. I went on a binge of eating a head nearly every day. My vitamin K intake prior to that was minimal and my weekly warfarin dose to stay in the therapeutic range was only 15mg. The lettuce did have an effect over a couple of months, so I am now on 18mg of warfarin per week, only a 20% increase. But anything less that a couple of cups of spinach or other of the dark "greens" known to be high in vitmain K is not going to do much short term.

 

[jarno1973]

Vitamin K can rapidly reverse warfarin, but to do so it must be given in rather large doses, something like 1 to 2 gm (1,000 to 2,000 mg). Note the usual daily intake of vitmain K is 100 mcg or 0.1 mg. Even doses of 1 to 2 gm of vitmain K takes a day or so to reverse warfarin. It takes time for the vitamin K dependent clotting factors to be synthesized. So, in cases of significant bleeding, to reverse warfain more rapidly, fresh frozen plasma (containing clotting factors) is used.

Small doses of vitmain K, less than 100 mcg, do almost nothing, at least short term to affect INR. Most green, leafy vegatables, other than kale, spinach, collard greens and mustard greens, do not have large amounts of vitmain k and would not have any dramatic effect in less than a week.

I've been experimenting personally with Romaine lettuce. I went on a binge of eating a head nearly every day. My vitamin K intake prior to that was minimal and my weekly warfarin dose to stay in the therapeutic range was only 1mg. The lettuce did have an effect over a couple of months, so I am now on 18mg of warfarin per week, only a 20% increase. But anything less that a couple of cups of spinach or other of the dark "greens" known to be high in vitmain K is going to do much short term.

Thanks for all replies..

 

[Bill B]

I corrected my post above after you quoted it. My weekly warfarin dose to stay in range went from 15 mg (not 1 mg) to 18 mg during my Romaine lettuce binge. Also inserted a "not" near the end of the last sentence. Sorry about the errors.