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Consistent Vitamin K Intake Is Key
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Patients taking blood-thinning drugs such as warfarin are told by doctors to reduce their intake of vitamin K because it’s believed too much of this vitamin can decrease the drug’s effectiveness. This is due to the belief that the vitamin interacts with the body’s clotting process and can interfere with the drug’s blood-thinning properties. This clinical trial is the first randomized controlled trial testing how people taking warfarin responded to dietary changes aimed at increasing vitamin K intake.
Half of the participants were provided dietary counseling sessions and cooking lessons that offered general nutritional advice. The rest attended counseling sessions and received cooking lessons that focused specifically on increasing consumption of vitamin K–rich vegetables, oils, and herbs. Guylaine Ferland, lead study author and professor of nutrition at Université de Montréal and scientist at the Montreal Heart Institute Research Centre, said the findings suggest patients on warfarin would significantly benefit from consuming at least 90 micrograms of vitamin K per day for women and 120 micrograms per day for men.
“Vitamin K is part of the complex process needed for the body to make clots, and warfarin blocks this process,” she said.
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Answer From Sheldon G. Sheps, M.D. There is no specific warfarin diet.
However, certain foods and beverages can make warfarin less effective in preventing blood clots. The adequate intake level of vitamin K for adult men is 120 micrograms (mcg). For adult women, it’s 90 mcg.
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However, questions persist about the risks and management of over-anticoagulation.
For reversal of excessive anticoagulation by warfarin, AVK withdrawal, oral or parenteral vitamin K administration, prothrombin complex or fresh frozen plasma may be used, depending on the excess of anticoagulation, the existence and site of active bleeding, patient characteristics and the indication for AVK. In over-anticoagulated patients, vitamin K aims at rapid lowering of the international normalized ratio (INR) into a safe range to reduce the risk of major bleeding and therefore improving patient outcome without exposing the patient to the risk of thromboembolism due to overcorrection, resistance to AVK, or an allergic reaction to the medication. Overcorrection of the INR or resistance to warfarin is unlikely if the above doses of vitamin K are used.
Vitamin K is less effective for over-anticoagulation after treatment with acenocoumarol or phenprocoumon than after treatment with warfari.
Abstract
The considerable variability in the warfarin dose–response relationship between individuals, is explained mainly by genetic variation in its major metabolic (CYP2C9) and target (VKORC1) enzymes. Despite the predominance of pharmacogenetics, environmental factors also affect the pharmacokinetics and pharmacodynamics of warfarin, and are often overlooked.
We deal separately with the effects of vitamin K on warfarin dose requirements during the induction of therapy, as opposed to its effect on stability of anticoagulation control during maintenance therapy. The role of vitamin K supplementation in warfarin treated patients with vitamin K deficiency as well as in patients with unstable warfarin anticoagulation, and The role of therapeutic vitamin K in cases of warfarin over-anticoagulation.