Warfarin causes dementia?

[Yankeeman2]

I had an artificial aortic valve installed in 2007 at Brigham & Women's in Boston. Now that I'm getting a little older, it seems that I've become a little more forgetful. Yesterday just for the hell of it I googled "warfarin" and "dementia" and it seems recent research indicates that long-term warfarin use can cause dementia if (an important "if") your INR is either too high or too low. Anybody heard anything about this? I've had a busload of doctors over the years and not one has ever mentioned that possibility.

 

[dick0236]

.........Yesterday just for the hell of it I googled "warfarin" and "dementia" and it seems recent research indicates that long-term warfarin use can cause dementia if (an important "if") your INR is either too high or too low.

My first question is what is meant by "too high or too low" and what is meant by "long term use". I think that if you allow your INR to be too high or too low for an extended period of time you will have problems a helluva lot worse than dementia

I have been on warfarin (over 52 years) since I was 31 years old.......now 84. At my "advanced age" of 84 I am no longer the sharpest knife in the drawer but I doubt I have dementia......but who knows. I'll let you know when my kids take my car keys away from me.

 

[LondonAndy]

I started off quite intrigued by the question, because most recently of course there has been more news about the benefits of being on Warfarin as a possibly protective medication if you are unfortunate enough to get Covid-19. Indeed I was starting to wonder if a low level dose of Warfarin would be sensible for all older people to take anyway to help reduce the risk of strokes. However, I then thought "what would I do if this is correct?" Am I going to stop taking Warfarin? Am I going to switch to an alternative? Well, for mechanical valves there currently is no alternative, and so the answer to both questions is "no", and my takeaway from this is to reinforce the importance of staying in therapeutic range - another reason that I am glad to be able to test my INR weekly with a home meter.

There are plenty of other potential causes of dementia and if this is added to the list I am not sure where in the risk level it would come but I think I need to increase my exercise level and improve my diet!

 

[pellicle]

warfarin causes:

• hair loss
• erectile dysfunction
• wrinkles
• feeling the cold
• feeling hot
• greying of hair
• ...

now sadly the reality is that warfarin is one of the longest prescribed drugs in modern medicine and is the target of every pharma who wants to kill off a 1c per pill drug to replace it with a $10per pill drug.

Somehow despite all that motivation they just can't find the evidence.

 

[user 16827]

Ahh, i wondered why i had started to go grey

 

[Superman]

warfarin causes:

• hair loss
• erectile dysfunction
• wrinkles
• feeling the cold
• feeling hot
• greying of hair
• ...

now sadly the reality is that warfarin is one of the longest prescribed drugs in modern medicine and is the target of every pharma who wants to kill off a 1c per pill drug to replace it with a $10per pill drug.

Somehow despite all that motivation they just can't find the evidence.

I’ve also experienced weight gain, weight loss, and unexpected children over the last 30 years on Warfarin! Scary stuff! And I’m still a couple years away from 50. The horror!

 

[LondonAndy]

I was going to add another complaint I would like to blame on Warfarin, but I have forgotten which one now ....

 

[pellicle]

but I think I need to increase my exercise level and improve my diet!

Fukkit I'm going to increase my diet, improve my exercise and standardise my drinking

 

[Yankeeman2]

Thank you all for your replies. I agree that there is no substitute for warfarin if you have a mechanical valve. I was encouraged by the information that it is possible to live with warfarin for a half-century and still not have dementia. However, the news that credible researchers have actually studied the link between warfarin and dementia sort of complicated my plans for remaining alive for awhile longer. (I'm 72) I already have mild cognitive disorder (confirmed several times at Brigham and Women's) which is a precursor to dementia. I have immediately redoubled my efforts to keep my INR in range (2.5 to 3.5) in the assumption that warfarin is clearly doing something to me besides preventing a cerebral hemorrhage or a stroke, and may have been responsible for me developing MCI in the first place. My cardiologist has for years more or less demanded that I stop drinking alcoholic beverages. I told him that I was drinking two beers a day and somehow I was still staying in range and have more or less ignored his advice. That changed recently when I tested at 6.2 after drinking the two beers together....that apparently kicked it up. (O'Doul's is made by Budweiser and is better than nothing, even without the alcohol) He's old school, so I can't test at home like I used to, but his INR enforcer told me to get ready to head for the emergency room if my stool showed any blood. It didn't and now I have to test almost daily at the lab.

 

[daVinci]

I'd heard of this before, my understanding was at high INR it can increase the likelihood of microbleeds in the brain, like how boxers can get microbleeds from repeated head trauma. They are then at higher risk of dementia from the accumulated damage. Would make sense to happen at low INR too r.e. microclots.

It's just about your body maintaining homeostasis. Which is what the warfarin helps with in the first place from the increased clot risk.

I wouldn't worry about it though, I'd be happy to take warfarin if needed and try and stay in range I'd just sit back and try to forget about it.

Life is good, entropy is in action on us all and increased risk doesn't mean the inevitable.

 

[Astro]

I don’t see a mechanism how warfarin could create dementia itself. Poor INR control leads to increased stroke risk. Multiple small strokes can create vascular dementia. However, in the situation of good INR control, I suspect that warfarin may have some modest benefit by preventing clots forming in the arteries leading to or in the brain. Can’t say that I have noticed a journal article addressing this question.

 

[daVinci]

I don’t see a mechanism how warfarin could create dementia itself. Poor INR control leads to increased stroke risk. Multiple small strokes can create vascular dementia. However, in the situation of good INR control, I suspect that warfarin may have some modest benefit by preventing clots forming in the arteries leading to or in the brain. Can’t say that I have noticed a journal article addressing this question.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6365433/
There's just one review for you. The section comparing warfarin to NOACs/DOACs is interesting.

Like you said, good INR control and maintaining that homeostasis between clot and bleed seems key. Pros and cons to everything.

 

[Superman]

Thank you all for your replies. I agree that there is no substitute for warfarin if you have a mechanical valve. I was encouraged by the information that it is possible to live with warfarin for a half-century and still not have dementia. However, the news that credible researchers have actually studied the link between warfarin and dementia sort of complicated my plans for remaining alive for awhile longer. (I'm 72) I already have mild cognitive disorder (confirmed several times at Brigham and Women's) which is a precursor to dementia. I have immediately redoubled my efforts to keep my INR in range (2.5 to 3.5) in the assumption that warfarin is clearly doing something to me besides preventing a cerebral hemorrhage or a stroke, and may have been responsible for me developing MCI in the first place. My cardiologist has for years more or less demanded that I stop drinking alcoholic beverages. I told him that I was drinking two beers a day and somehow I was still staying in range and have more or less ignored his advice. That changed recently when I tested at 6.2 after drinking the two beers together....that apparently kicked it up. (O'Doul's is made by Budweiser and is better than nothing, even without the alcohol) He's old school, so I can't test at home like I used to, but his INR enforcer told me to get ready to head for the emergency room if my stool showed any blood. It didn't and now I have to test almost daily at the lab.

Thanks for the additional color and perspective. We can be a jaded bunch here. Apologies for making light of your concerns. I see where your question/thoughts are coming from.

The only suggestion I’d have you consider is shopping for a new cardio. Loyalty is great, but when it’s your health, your first loyalty should be to you. Especially if your cardio won’t let you home test. That should be a minimum litmus test for a provider one is willing to work with.

 

[ScribeWithALancet]

I don’t see a mechanism how warfarin could create dementia itself. Poor INR control leads to increased stroke risk. Multiple small strokes can create vascular dementia. However, in the situation of good INR control, I suspect that warfarin may have some modest benefit by preventing clots forming in the arteries leading to or in the brain. Can’t say that I have noticed a journal article addressing this question.

There are two leading causes of plaque in blood vessels. They are glycated HDL/LDL particles and oxidated HDL/LDL particles. Unglycated and unoxidated particles almost never deposit as they are the bodies food transport mechanism and garbage return mechanism. If you read Dr. Atkins and Dr. Bernstein's books on diabetes and do a bit of work on the NIH Pubmed web site, this becomes clear. I believe you are correct that warfarin may have some modest benefit so long as you are in range. I read an article on the side effects of warfarin where the pharmacist argued that most of the side effects of warfarin (bleeding and clotting excepted) are actually side effects of lack of vitamin K1 and K2.
Glycated plaque arises mostly from too much sugar and carbohydrates resulting in a high A1c and the damaged particles that test measures. Oxidated plaque arises primarily from smoking. Both are avoidable. My opthamologist says that being a diabetic or a smoker are leading causes of blindness. This is because the small fragile blood vessel in the eyes are easily damaged.
You might also read "Alzheimer's Disease - What if there was a Cure?" subtitle "The Story of Ketones" by Mary T. Newport, M.D. She makes the case that use of Anti-Cholergenic drugs (Mostly over the counter antihistamines and anticongestants" and lots of total anesthesia are major contributors to dementia. I subsequently found studies of residents of nursing homes in South Korea and Taiwan that confirmed this.
Scribe With a Lancet

 

[ScribeWithALancet]

There are two leading causes of plaque in blood vessels. They are glycated HDL/LDL particles and oxidated HDL/LDL particles. Unglycated and unoxidated particles almost never deposit as they are the bodies food transport mechanism and garbage return mechanism. If you read Dr. Atkins and Dr. Bernstein's books on diabetes and do a bit of work on the NIH Pubmed web site, this becomes clear. I believe you are correct that warfarin may have some modest benefit so long as you are in range. I read an article on the side effects of warfarin where the pharmacist argued that most of the side effects of warfarin (bleeding and clotting excepted) are actually side effects of lack of vitamin K1 and K2.
Glycated plaque arises mostly from too much sugar and carbohydrates resulting in a high A1c and the damaged particles that test measures. Oxidated plaque arises primarily from smoking. Both are avoidable. My opthamologist says that being a diabetic or a smoker are leading causes of blindness. This is because the small fragile blood vessel in the eyes are easily damaged.
You might also read "Alzheimer's Disease - What if there was a Cure?" subtitle "The Story of Ketones" by Mary T. Newport, M.D. She makes the case that use of Anti-Cholergenic drugs (Mostly over the counter antihistamines and anticongestants" and lots of total anesthesia are major contributors to dementia. I subsequently found studies of residents of nursing homes in South Korea and Taiwan that confirmed this.
When my parents went into assisted living and nursing homes, they were fed lots of carbohydrates. Our son, who can read blood tests, found that they were starving for protein and fat even while being fed lots of carbs. My dad's pulmonologist looked at the tests and confirmed that he had been starving for at least five years even while being fed lots of food. Their health got much worse after entering the nursing homes.
Scribe With a Lancet

 

[Warrick]

Read this and it seems to suggest its a higher dose rather than a high inr.
“their blood levels of the medication were frequently too high” #fakenews
https://www.cbsnews.com/amp/news/popular-afib-heart-drug-warfarin-linked-to-dementia-risk/Which only adds fuel to the misinformed concerns imo of people whos inr needs to be maintained with “higher” doses of warfarin.

So if it is the micro bleeds theory then wouldn’t this pertain to most if not all of the anticoagulants like

• rivaroxaban (Xarelto)
• dabigatran (Pradaxa)
• apixaban (Eliquis)
• edoxaban (Savaysa)
• enoxaparin (Lovenox)
• fondaparinux (Arixtra)

And with the other anticoagulants possibly could the potential for microbleeds be greater given that the individual anticoagulation effects are not measured or monitored as such?

 

[pellicle]

Read this and it seems to suggest its a higher dose rather than a high inr.
“their blood levels of the medication were frequently too high” #fakenews

sorry, but I'm not even going to read CBS news for any medical factual data

So if it is the micro bleeds theory then wouldn’t this pertain to most if not all of the anticoagulants like

there you go again ... bringing rational analysis to an emotional argument

 

[Warrick]

Stumbled across this just now while googling if ibruprofen is linked to dementia, ibruprofen was mentioned today when it was suggested by a young cardiologist registrar as I have costochondritis, until I reminded him Im on warfarin.
https://www.ucsf.edu/news/2017/06/4...ed-increased-risk-dementia-study-older-adults

 

[pellicle]

told him that I was drinking two beers a day and somehow I was still staying in range and have more or less ignored his advice

Perfect.
Myself I was sampling two whiskies tonight

Lovely stuff

That changed recently when I tested at 6.2 after drinking the two beers together....that apparently kicked it up.

Hard to be sure that was the cause.

Sorry to hear you've been stripped of the right to self test.

Best wishes

 

[tom in MO]

Thank you all for your replies. I agree that there is no substitute for warfarin if you have a mechanical valve. I was encouraged by the information that it is possible to live with warfarin for a half-century and still not have dementia. However, the news that credible researchers have actually studied the link between warfarin and dementia sort of complicated my plans for remaining alive for awhile longer. (I'm 72) I already have mild cognitive disorder (confirmed several times at Brigham and Women's) which is a precursor to dementia. I have immediately redoubled my efforts to keep my INR in range (2.5 to 3.5) in the assumption that warfarin is clearly doing something to me besides preventing a cerebral hemorrhage or a stroke, and may have been responsible for me developing MCI in the first place. My cardiologist has for years more or less demanded that I stop drinking alcoholic beverages. I told him that I was drinking two beers a day and somehow I was still staying in range and have more or less ignored his advice. That changed recently when I tested at 6.2 after drinking the two beers together....that apparently kicked it up. (O'Doul's is made by Budweiser and is better than nothing, even without the alcohol) He's old school, so I can't test at home like I used to, but his INR enforcer told me to get ready to head for the emergency room if my stool showed any blood. It didn't and now I have to test almost daily at the lab.

At 72, Medicare will pay for you to home test. Two beers should not effect your INR, it may be something else (e.g. no vitamin K foods in your diet that week, too long between tests.) Having an INR of 6.2, but not letting you home test is unusual. Maybe he would let you if you had someone you live with help out with the testing. You might want to think of finding a younger cardiologist as well, older doctors can suffer from cognitive difficulties too

Don't forget that cognitive difficulties can be caused by living past 60, the age at which you become medically "elderly." Everyone who lives suffers from cognitive problems as they get older. It's normal and not a "disorder".