Many drugs interact with coumadin and may cause more anticoagulation effect (clofibrate, diazoxide, ethacrynic acid, nalidixic acid, phenylbutazone, salicylates, aspirin, sulfonamides, alcohol, allopurinol, amiodarone, cimetidind, phenytoin, erythromycin, gemfibrozil, propranolol, thyroid drugs) or decreased anticoagulation effect (smoking, estrogens, vitamin K, aluminum hydroxide – antacids, cholestipol, spironolactone). The effects of coumadin must be carefully monitored by a blood test called an INR. Usually this is checked more often at the onset of taking the drug and less often once a steady state has been reached. Therapeutic INR is usually 2 to 3 depending on the condition being treated.
There are naturally occurring substances and foods that reduce platelet aggregation and act as natural blood thinners. In some circumstances the use of a prescription anticoagulant may not be necessary when using these. However, when on a prescription anticaoagulant, caution should be maintained regarding the use of large amounts of substances like green tea, ginkgo, garlic and vitamin E.
Anticoagulant Use can lead to
Increased Risk of Stroke
Atrial fibrillation is the most common clinically significant cardiac arrhythmia and a major risk factor for ischemic stroke and peripheral embolism. Anticoagulant use reduces this risk.
Metabolic Syndrome (Syndrome X)
The link between osteocalcin, type 2 diabetes, and the full metabolic syndrome has just been confirmed in the medical literature. It will only be a matter of time before research shows that disrupting osteocalcin activity with warfarin either causes type 2 diabetes and metabolic syndrome or makes it worse.
Hypokalemia / Potassium Need
Heparin therapy may cause hyperkalemia (abnormally high potassium levels). Potassium supplements, potassium-containing salt substitutes (No Salt, Morton Salt Substitute, and others), and even high-potassium foods (primarily fruit) should be avoided by persons on heparin therapy, unless directed otherwise by their doctor.
Increased Risk of Diabetes ll
The link between osteocalcin, type 2 diabetes, and the full metabolic syndrome has just been confirmed in the medical literature. It will only be a matter of time before research shows that disrupting osteocalcin activity with warfarin either causes type 2 diabetes and metabolic syndrome or makes it worse.
Recommendations for Anticoagulant Use
Herbal Combinations
Although there are no specific studies demonstrating interactions with anticoagulants, the following herbs contain coumarin-like substances that may interact with heparin and could conceivably cause bleeding. These herbs include dong quai, fenugreek, horse chestnut, red clover, sweet clover, and sweet woodruff. Consult a healthcare professional if taking an anticoagulant and wishing to use one of these herbs.
Medicinal Mushrooms
As it may increase bleeding time, reishi is not recommended for those taking anticoagulant (blood-thinning) medications.
Ginger Root (Zingiber officinalis)
Ginger has been shown to reduce platelet stickiness in test tubes. Although there are no reports of interactions with anticoagulant drugs, people should consult a healthcare professional if they are taking an anticoagulant and wish to use ginger.
Ginkgo Biloba
Ginkgo extracts may reduce the ability of platelets to stick together, possibly increasing the tendency toward bleeding. Standardized extracts of ginkgo have been associated with two cases of spontaneous bleeding, although the ginkgo extracts were not definitively shown to be the cause of the problem. There is one case report of a patient taking warfarin in whom bleeding occurred after the addition of ginkgo. People taking heparin should consult with a physician knowledgeable about botanical medicines if they are considering taking ginkgo.
Alcohol Avoidance
Alcohol consumption during heparin therapy may increase the risk of serious bleeding. It is important for people receiving heparin to avoid alcohol during the entire course of heparin therapy.
Conventional Drugs / Information
Continued anticoagulant use is recommended, although the dose may need to be reduced or even eliminated when taking natural anticoagulants. Lab test monitoring is necessary to make sure that the blood is not overly thinned.
Vitamin K1/K2
Significantly increasiing your vitamin K intake while on anticoagulant therapy can reduce the desired effect. Only change you vitamin K intake with your doctor’s approval.
Key
| Strong or generally accepted link |
| Strongly counter-indicative |
| Likely to help |
| May have adverse consequences |
| Reasonably likely to cause problems |
Glossary
Thyroid
Thyroid Gland: An organ with many veins. It is at the front of the neck. It is essential to normal body growth in infancy and childhood. It releases thyroid hormones - iodine-containing compounds that increase the rate of metabolism, affect body temperature, regulate protein, fat, and carbohydrate catabolism in all cells. They keep up growth hormone release, skeletal maturation, and heart rate, force, and output. They promote central nervous system growth, stimulate the making of many enzymes, and are necessary for muscle tone and vigor.
Vitamin K
Helps the blood clot when the body is injured.
Antacid
Neutralizes acid in the stomach, esophagus, or first part of the duodenum.
Anticoagulant
A substance that prevents or delays blood clots (coagulation).
Vitamin E
An essential fat-soluble vitamin. As an antioxidant, helps protect cell membranes, lipoproteins, fats and vitamin A from destructive oxidation. It helps protect red blood cells and is important for the proper function of nerves and muscles. For Vitamin E only, 1mg translates to 1 IU.
Cardiac
Pertaining to the heart, also, pertaining to the stomach area adjacent to the esophagus.
Arrhythmia
A condition caused by variation in the regular rhythm of the heartbeat. Arrhythmias may cause serious conditions such as shock and congestive heart failure, or even death.
Ischemia
Localized tissue anemia due to obstruction of the inflow of arterial blood.
Stroke
A sudden loss of brain function caused by a blockage or rupture of a blood vessel that supplies the brain, characterized by loss of muscular control, complete or partial loss of sensation or consciousness, dizziness, slurred speech, or other symptoms that vary with the extent and severity of the damage to the brain. The most common manifestation is some degree of paralysis, but small strokes may occur without symptoms. Usually caused by arteriosclerosis, it often results in brain damage.
Embolism
Obstruction of a vessel by an abnormal body, usually a detached blood clot.
Diabetes Mellitus
A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.
Metabolism
The chemical processes of living cells in which energy is produced in order to replace and repair tissues and maintain a healthy body. Responsible for the production of energy, biosynthesis of important substances, and degradation of various compounds.
Potassium
A mineral that serves as an electrolyte and is involved in the balance of fluid within the body. Our bodies contain more than twice as much potassium as sodium (typically 9oz versus 4oz). About 98% of total body potassium is inside our cells. Potassium is the principal cation (positive ion) of the fluid within cells and is important in controlling the activity of the heart, muscles, nervous system and just about every cell in the body. Potassium regulates the water balance and acid-base balance in the blood and tissues. Evidence is showing that potassium is also involved in bone calcification. Potassium is a cofactor in many reactions, especially those involving energy production and muscle building.