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extremely confused!!

Posted by whitehaven 
extremely confused!!
June 14, 2018 11:29AM
Hi all,

I'm fairly new to afib and recently I was put on Coumadin. It's been over one month and my INR won't budge from
.9. I've cut out mostly all green vegetables, increased by fish oils, garlic, vit E, natto,, etc. Thinking about
trying cranberry juice. I take a lot of magnesium, different forms ( mag glycinate, mag ascorbate and I was taking
mag citrate but I stopped because I read something about mag citrate online).

Has anyone had a similar problem trying to increase their INR levels? Any advice would be greatly appreciated.
Thanks in advance.
Re: extremely confused!!
June 14, 2018 11:38AM
Why not take a larger dose?
Re: extremely confused!!
June 14, 2018 01:04PM
i'd prefer not to have to keep increasing my dosage. currently taking 4mg, 7 days a week.
Re: extremely confused!!
June 14, 2018 01:18PM
Quote
whitehaven
i'd prefer not to have to keep increasing my dosage. currently taking 4mg, 7 days a week.

If you're not willing to adjust to a working dosage, try an NOAC. No point in testing if you prefer not to use the information.

PS Far better to stick to a healthy diet and dose accordingly



Edited 1 time(s). Last edit at 06/14/2018 01:22PM by jpeters.
Re: extremely confused!!
June 14, 2018 01:29PM
jpeters is right. The very nature of warfarin requires dosage adjustment in response to INR results. If you're not willing to adjust the dosage then warfarin is the wrong drug for you. As it stands now, whatever benefit you perceive from not increasing the dosage is completely negated by the far greater risk of stroke you're subjecting yourself to.
Re: extremely confused!!
June 14, 2018 02:06PM
BTW, am I sabotaging myself by including vit k2 in my diet in the form of gouda cheese? According to a website www.algaecal.com,
vitamin K2 in its MK-7 form is off limits for people taking warfarin. Research revealed that daily intakes of 10 and 20 micrograms of
MK-7 were found to lower the INR in at least 40 to 60% of the subjects. According to this study even tiny doses of MK-7 had no
beneficial effect on increasing activation of matrix Gla protein, which was what they measured because this is the vitamin K dependent
protein that prevents calcium from depositing in blood vessels. Virtually all the MK-7 got side tracked to activate blood clotting
proteins/prothrombin.

If I do decide to stop taking warfarin, what is the majority consensus of which drug to take with the lease amount of side effects?

Thanks again for all your help during this difficult time.
Re: extremely confused!!
June 14, 2018 03:58PM
Many people on warfarin eat plenty of leafy greens. If you need K2 suppliments, that may be another consideration for choosing an NOAC (but don't believe that they don't have their own list of problems).



Edited 1 time(s). Last edit at 06/14/2018 04:04PM by jpeters.
ron
Re: extremely confused!!
June 14, 2018 07:59PM
Whitehaven, I took coumadin for 6-7 years needing 56-68 mg weekly to stay in inr range. I included lots of greens in my diet and did take K2 as MK7 during that time. That was some years ago and I now take Eliquis. I also tried Pradaxa for a year and developed acid reflex, so that didn't work for me.

You need to talk to whoever is monitoring your coumadin to establish what is needed for you. Many can get by with 4 mg daily and others need 8-10 mg to stay in range.

In my opinion, there is no point taking coumadin unless you are willing to be tested and do what they tell you.

Best of luck to you, ron
Re: extremely confused!!
June 14, 2018 08:09PM
I take Eliquis and have been taking it for several years....no regular testing ever needed and no dietary restrictions. Neither have I experienced any side effects or unusual bleeding. It is more expensive than coumadin...but worth the difference in convenience and perhaps effectiveness. There are other newer anticoagulants that you might take depending on what your EP recommends....Pradaxa, Xarelto, and Savaysa. Eliquis seems to have a better record of not causing internal bleeds than some of the others according to my electorphysiologist. Talk to your EP about changing your medication if coumadin is proving too hard for you to regulate. He/she can recommend what would be the better one for your particular case.
By the way, there are now reversal agents approved by the FDA for Pradaxa, Eliquis, Xarelto, and Savaysa if you are concerned about the bleeding risk..
Hope you find a good solution and wish you the best!
J.A.
Re: extremely confused!!
June 14, 2018 09:02PM
Quote
whitehaven
i'd prefer not to have to keep increasing my dosage. currently taking 4mg, 7 days a week.

People with different genetics will metabolize Coumadin differently. Don't recall the SNP's but I know I would need more if I took it (I was on it 14 years ago for 3 months). From this great time distance, I recall I took significantly more than what you are taking.

George
Re: extremely confused!!
June 14, 2018 09:56PM
Quote
whitehaven
If I do decide to stop taking warfarin, what is the majority consensus of which drug to take with the lease amount of side effects?

How old are you?
Re: extremely confused!!
June 14, 2018 10:49PM
I take Elequis as well. Been on it since January with no issues.
Re: extremely confused!!
June 15, 2018 10:56AM
whitehaven - as you point out in your initial post, eliminating many healthy foods to help with the INR seems to be counterproductive. The advantage with Eliquis and similar is being able to eat a healthy, nutritionally-balanced diet. The other issue with warfarin that isn't typically mentioned when prescribed, is the long-term effect on tissues that can become calcified... therefore the recommendation for the K2 MK7 is very significant to help prevent that from happening. That said, how many patients are actually prescribed that?

Jackie
Re: extremely confused!!
June 15, 2018 05:54PM
I'm another who just switched from coumadin to Eliquis .
Had to take ~ 50mg week coumadin to reach 2. and often had to
adjust. Which means getting checkup's more often.
Joe
Re: extremely confused!!
June 15, 2018 07:18PM
Quote
Jackie
whitehaven - as you point out in your initial post, eliminating many healthy foods to help with the INR seems to be counterproductive. The advantage with Eliquis and similar is being able to eat a healthy, nutritionally-balanced diet. The other issue with warfarin that isn't typically mentioned when prescribed, is the long-term effect on tissues that can become calcified... therefore the recommendation for the K2 MK7 is very significant to help prevent that from happening. That said, how many patients are actually prescribed that?

Jackie

Nobody i know.
Re: extremely confused!!
June 16, 2018 03:17AM
After researching a bit, seems like a lot of Warfarin users do fine supplimenting with MK-7, despite the warnings and myths.
Re: extremely confused!!
June 16, 2018 10:07AM
jpeters - yes... that's the point of mentioning MK7 -- it is menaquinone 7 form... a different component of vitamin K whereas K1 is the Phylloquinone form.

When taking warfarin, because it tends to cause soft tissue calcifications such as arterial and even lung tissue, the advice by knowledgeable physicians is to also take the MK7 which helps prevent the Ca deposits by directing circulating calcium to bone "where it belongs"... and not in soft tissues.

It's useful for everyone overall to prevent those calcifications.

There is an abundance of reliable research out of the University of Maastricht, Netherlands... by leading Vitamin K researchers Cees Vermeer, PhD and Leon Schurgers, PhD. easily located online.... and a variety of posts here on the topic in the archives.

Jackie
Re: extremely confused!!
June 17, 2018 01:38AM
Hi Whitehaven,

As for the Vitamin K2-MK7 study you quoted, the majority of studies Ive seen on the topic of Warfarin and K2-MK7/MK4 ... and Ive read a good number of them over the years ... fully support using 45mcg daily dose of K2-MK7 with a stable dose of Warfarin. Adding the K2-MK7 has been shown to help stabilize INR in many folks in whom INR was unstable and all over the map when they excluded all Vitamin K in the diet including K2 and K1 supplements,

Adding 45mcg of K2-MK7 when ion warfarin did help stabilize my previously Labile INR levels. And keep in mind lots of seemingly 'good studies' are full of holes!

Lastly, as George noted, a good number of people genetically run through their warfarin dose to quickly and thus need a whole lot larger dose inherently than the typical 4mg to 5 mg a day dose.

I was one of those people who required 15mg a day of Warfarin as I do/did possess this genetic issue. Even at 15 mg/day I barely kept my INR at 1.9 and this was before adding in the small dose of K2-MK7. After adding the 45mcg/day of K2-MK7 Ironically I ran more consistently in the lower 2s, but fortunately my days with Warfarin were over with the total elimination of my aggressive persistent AFIB after a then 16 years of progression. And all thanks to a two-part expert ablation process by Dr Natale many many moons ago!

You may well have the same genetic issue and thus why you seem stuck on 0.9 INR which is exactly where I was stuck (that is the baseline number) until I got the genetic test that proved the point and St Davids NP increased my dose straight away to 15 mg and before you know it I was responding reasonable well ... this was before any NOACS existed.

Cheers!
Shannon
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