Supplements, Diet and Warfarin

[BionicBuddy]

I have always been able to do what my friends did. Unfortunately, most, if not all my "buddies" are now dead. Time and age are now wearing on me and I can't run with the big dogs anymore.......but it has been a good run.

Wow. You're truly a bionic Steve Austin $6 million dollar man. (I'm dating myself here). What do you mean by "big dogs"? People your age? or much younger and your SAVR plays no role in your aging process? Just that you can't do what a healthy 70 year old could do, let's say?

 

[dick0236]

Wow. You're truly a bionic Steve Austin $6 million dollar man. (I'm dating myself here). What do you mean by "big dogs"? People your age? or much younger and your SAVR plays no role in your aging process? Just that you can't do what a healthy 70 year old could do, let's say?

LOL...."big dogs" is just slang for "I can't do what I used to do"........and I wouldn't even try to keep up with a 70-year-old youngster.......but I did stay up with them until I hit my mid-80s........then things went "south". That's when I added "live one day at a time" to my signature.

 

[BionicBuddy]

That's when I added "live one day at a time" to my signature.

I guess you're savouring every bite of the elephant every day. Good on you!! You're the ultimate inspiration.

 

[pellicle]

So I guess you're saying that dosage doesn't matter (but 12 mg would seem a bit scary to me), but it's the INR that matters to keep it within the target range.

correct the dosage does not matter. Doctors don't grasp this either, so don't feel concerned.

The intention to treat with warfarin is only INR. No other issue ... just INR.

I know people who take 1.5mg per day, which is a PITA to be honest because adjusting your dose between 1.3 and 1.6mg is not even reliable.

Equally there are people who require 60mg of warfarin per day ...

I have zero conceptual idea as to why anyone thinks taking more is dangerous. I mean if you were taking 1000mg daily (like you would with paracetamol, perhaps even you'd take 2000mg per day as that's just 4 pills) it would still be no more harmful to your body than taking 1000mg of paracetamol.

12 thousandths a a gram ... its not even a grain of salt (and I mean a grain, not the Olde English meaning of a pinch of salt)

Do you drink Alcohol? One "standard" drink is 10g of alcohol (so that's ten thousand milligrams or 10,000mg) ... Alcohol is a known toxin with well known pathways for cellular destruction within the body.



I'm not saying don't drink I'm saying insert some reality about warfarin. (I drank a drink or two a day right up till last year when I got massive tachycardia from it).

I'm wondering where you got your information on warfarin, from "the internet" or a clinician? Either are as likely to know nothing about it. Here at least you are talking with people who have taken warfarin for (in many cases) over 10 years personally.

The arguments against eating a healthy diet are not supported logically nor scientifically. IMO the utter bottom of the science ladder are dieticians. They know enough to be dangerous. They read that Warfarin method of action is a Vitamin K Antagonist (VKA) and so tell you to steer clear of Vitamin K. This does only harm (not even more harm than good).

From

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4998867/

The study has limitations. The main limitation is represented by the small sample size of most studies addressing the interaction between warfarin and dietary vitamin K intake...​

... A logical consequence of all these arguments is that the above-reported studies do not support the putative interaction between food and VKA and warrant more appropriate trials to firmly conclude that an interaction between food and VKAs does exist.​

so what they are saying in that above study is: its poorly studied with almost no evidence to support it. Yet clinicians tell people to not eat a healthy diet which has plenty of evidence of harm.

Worse this harm extends to you believing this twaddle and perhaps doubting the (already many) people how have strongly asserted they eat normally (struck out because the normal US diet is not healthy) a healthy diet filled with greens.

 

[BionicBuddy]

Do you drink Alcohol?

Never. Nor does hubby. And we're not boring, I promise!

I'm wondering where you got your information on warfarin, from "the internet" or a clinician? Either are as likely to know nothing about it. Here at least you are talking with people who have taken warfarin for (in many cases) over 10 years personally.

I posted in another response that I was an ICU/CCU/ER nurse 40 years ago. I saw a lot of bleeding. Warfarin has always scared me. But in reading this forum, it's very apparent that you folks know much more than the medical profession about managing your own INRs. In this department I will go with experience over "education/authority" every time.

The arguments against eating a healthy diet are not supported logically nor scientifically. IMO the utter bottom of the science ladder are dieticians. They know enough to be dangerous. They read that Warfarin method of action is a Vitamin K Antagonist (VKA) and so tell you to steer clear of Vitamin K. This does only harm (not even more harm than good).

Apparently so, and I am slowly learning this, thanks to this forum.

 

[tom in MO]

Never. Nor does hubby. And we're not boring, I promise!

I posted in another response that I was an ICU/CCU/ER nurse 40 years ago. I saw a lot of bleeding. Warfarin has always scared me. But in reading this forum, it's very apparent that you folks know much more than the medical profession about managing your own INRs. In this department I will go with experience over "education/authority" every time.

Apparently so, and I am slowly learning this, thanks to this forum.

40 years ago warfarin therapy was different. One dieted the dose, not dosed the diet. What's still a mystery about warfarin is the science behind dosage, why some need 5 mg a day and others 20 mg a day. I had to stay a couple of extra days in the hospital until my INR/Dose had settled down for at least two days. Luckily the non-therapeutic effects of warfarin (i.e. side effects) are not dramatic so there isn't a negative for having to take 20 vs. 5 mg.

 

[dick0236]

I posted in another response that I was an ICU/CCU/ER nurse 40 years ago. I saw a lot of bleeding. Warfarin has always scared me.

40 or so years ago there was NO INR system and we, pretty much, had our PT (pro-thrombin time) monitored in a very un-scientistic way.
......my pro-time was maintained at 1-1/2 x normal PT, about 18 seconds......way too low for that valve design. A stroke waiting to happen!

My dosing instructions were" If your urine turned brown or red....hold your Coumadin. I don't think there were any instructions if your blood got too "thick".......I guess you just had a stroke (or TIA) and I did!

As I recall there was LITTLE or NO info available to the patient concerning anti-coagulant management. We just "blindly" followed doctors' instructions without question. That was a very naive time.

With the INR system, home testing, much better clinical experience, patient education (via good internet sites), and good common sense warfarin is a very manageable drug.

 

[vitdoc]

INR and pro time are essentially the same. With pro time there was a lot of variability from lab to lab. INR was introduced to limit the variability. So controls are used that in theory give more standardized results.

 

[dick0236]

INR and pro time are essentially the same.

As has been explained to me INR and pro-time both measure blood coagulation time. Pro-time measures coagulation in seconds while INR is simply a number(INR) that has been developed to equalize those numbers. An INR of 1=PT Rato of 1= PT of 12 seconds.

An INR of 2=PT Ratio of 1.79=PT of 21 seconds.

An INR of 3=PT Ratio of 2.52=PT of 30 seconds.

These values are taken from "Typical relationship of the PT (seconds) to the INR" as posted to the internet by the University of Texas, Sam Antonio, Tx

 

[pellicle]

This is an interesting point

40 or so years ago there was NO INR system and we, pretty much, had our PT (pro-thrombin time) monitored in a very un-scientistic way

some amusing (to me) timelines

• 1922 insulin therapy began for diabetics
• 1954 warfarin therapy was approved for clinical huse
• 1955 President Dwight D. Eisenhower began warfarin therapy (lived to over 79 years)
• 1980's electronic tools were available and became common place for measurement and led to full self administration of insulin for diabetics by injection
• 1980's WHO develops the INR system
• 2000 Roche Coaguchek S system available ...

so 24 years after this do we see valvers getting trained like diabetics are or are some developed countries still dragging their feet on getting this technology into the hands of patients and enabling them?
From reading here the myths are still around that you can't do it yourself, its too heard to do it yourself, we won't train you, and you have to come to us.

Seems weird to me

 

[Timmay]

pellicle already answered the question you asked of me - why I’m taking “so much” warfarin. I’m not taking so much. I’m taking what my body needs to keep INR where I want it. It’s not dangerous to be on the amount of warfarin that I am on. There are plenty of people who are on a lot more. And plenty who are on less. Makes no difference. You take what you need to keep INR where it needs to be.

Prior to taking K2 I was on about 11.5mg a day. There have also been times that 10mg was fine. I dose my diet. Like others here.

The amount of K1 in my multivitamin is minuscule. I probably shouldn’t even have mentioned it.

 

[BionicBuddy]

pellicle already answered the question you asked of me - why I’m taking “so much” warfarin. I’m not taking so much. I’m taking what my body needs to keep INR where I want it. It’s not dangerous to be on the amount of warfarin that I am on.

Yes, I understand that now. I asked you that when I was at the beginning of my learning. You were one of the early responders to my question. Thanks!

 

[pellicle]

INR and pro time are essentially the same. With pro time there was a lot of variability from lab to lab. INR was introduced to limit the variability. So controls are used that in theory give more standardized results.

AFAIK INR and PT will only differ if the lab hasn't properly applied the ISI for the reagent.

https://www.clinicaladvisor.com/home/my-practice/medical-calculators/inr-calculator/
the main benefit of INR is the simplicity of the number system

• 1 is normal
• 2 to 3 is a typical range for a modern mechanical in the aortic position
• 2.5 to 3.5 is typical for a modern mechanical in the mitral position

its simpler than dealing with numbers like between 26 seconds to 35.8 seconds

please let me know if I'm mistaken in this understanding

 

[carolinemc]

As has been explained to me INR and pro-time both measure blood coagulation time. Pro-time measures coagulation in seconds while INR is simply a number(INR) that has been developed to equalize those numbers. An INR of 1=PT Rato of 1= PT of 12 seconds.

An INR of 2=PT Ratio of 1.79=PT of 21 seconds.

An INR of 3=PT Ratio of 2.52=PT of 30 seconds.

These values are taken from "Typical relationship of the PT (seconds) to the INR" as posted to the internet by the University of Texas, Sam Antonio, Tx

So true, for my hospital people know when I say I am there for Protime, or INR.

 

[pellicle]

Hi Dick

do you have a link to this:

An INR of 2=PT Ratio of 1.79=PT of 21 seconds.
An INR of 3=PT Ratio of 2.52=PT of 30 seconds.

These values are taken from "Typical relationship of the PT (seconds) to the INR" as posted to the internet by the University of Texas, Sam Antonio, Tx

I googled the title and University of Texas ... no luck

I'm curious because this is somewhere between wrong and incomplete; because the PT Ratio needs the ISI to form an INR figure.

ISI is part of the calculation of INR:

However without the actual ISI of the reagent I can't make proper calculations and that given ratio is pretty useless too.

...which is why I wanted to read that source you're quoting.

From my Coaguchek (which calculates the ISI of the reagent internally as that's what's on the code chip)

I've graphed a few points and placed each on a scale of INR units spaced by 0.1 (which is what the XS reports, only one decimal place and the Prothrombin Time (which it also reports for each point sored in its memory, retrieved by pressing M (from powered off) to go the memory then pressing blue button on the side shows the PT, pressing M moves to the prior historical point).

Note that each point is on a straight line and for the ISI of that reagent can be calculated at about 1.1

Sorry for nerding out

HTH

 

[dick0236]

Sorry Pel, I printed this off the internet in 2013 and, as you know, I can only fumble and bumble my way around the computer. If it helps the following is the address that is shown on my copy:
http://labs.uhstx.com/clinical_int/dols/ptinr.htm

cheers!

 

[Protimenow]

I take a fair amount of supplements - Vitamin C, Calcium, Magnesium, Zinc, K2, and multivitamins. I regulate my INR based on these supplements and stay in range.

I recently started taking NMN (which the FDA has recently ordered unavailable OTC because there's research being done on it as a possible drug). It's a precursor to NAD+, which is still available OTC. My skin has improved, My eyesight seems to have improved a little. My INR hasn't changed.

Over the years, my INR dose has changed - from a low of 5 to a high of 7.5.

I used to take different doses on different days, shooting for an average over the week.

This is a bad approach if you're self-testing -- your measured INR will vary based on your dosage a few days before testing. For example, if you take a different dosage every other day, and test daily, you'll see different results. If you make your dosing changes based on ONE DAY results, you may over or under dose.

I'm taking the same dose daily. It's not hard to do - warfarin is available in different doses, and it isn't hard to make up the correct daily dose.

One thing about NSAIDs - they ALL have similar effects on platelets - whether it's aspirin, ibuprofen, or naproxen. NONE are completely safe for long term usage. I take 81 mg enteric coated aspirin at bedtime - but avoid NSAIDs unless I'm in a LOT of pain and Acetaminophen doesn't cut it.

If you are taking NSAIDs for more than a day or two at a time, talk to your doctor about it.

 

[Protimenow]

Pellicle's information is absolutely correct.

When I started recording my INR in 2009, I was recording INR and prothrombin time. I realize that saving the prothrombin time was an exercise that was of no value -- INR is the ratio between prothrombin time and reagent value. When reagent values change, INRs also change.

Labs use reagent values provided by their supplier. Meter makers are probably even more careful about the values associated with their strips - this is why CoaguChek XS strips come with chips (they provide the reagent value necessary to calculate INR), and Coag-Sense records a value on the strips (or each new batch) - to assure that results are accurate. They have to be careful that all tests using their machines and strips are 'accurate.'

(In my recent experience - the past two or three years - Coag-Sense values have been consistently lower than CoaguChek - I rarely use Coag-Sense for testing. I used to advocate for the Coag-Sense, but I don't now).

 

[BionicBuddy]

I do understand. You dose the diet, not the other way around. And I understand that there are those eating kale, spinach, etc., now and then, and are doing just fine stabilizing their INR. And I understand that everyone's response to foods is individual. I've also read a few of the Vitamin K and anticoagulant studies on this forum that were helpful.

Given the above, I would still like to know if there is anyone on the forum taking Warfarin, who drinks powdered green drinks every day? You know, the kind with barley grass, broccoli, cauliflower, kale, spinach, collards, berries, etc. etc. etc. If so, how is it working out for you with your INR management?

Thanks in advance.

 

[LondonAndy]

who drinks powdered green drinks every day? You know, the kind with barley grass, broccoli, cauliflower, kale, spinach, collards, berries, etc. etc. etc.

... and if so, whether you actually like it ....