Acitrom and Warfarin-Walking on a Tight Rope

This is an educational post related to patients who are on warfarin and acitrom.

If you are on acitrom or warfarin (together known as oral anticoagulants), you might be aware of INR, Vitamin K Diet, and the lifestyle modification, use of such drug demand. One must be very vigilant about diet and his/her lifestyle while on these drugs. I am writing this article, keeping in mind my patients who are on oral anticoagulants (acitrom or warfarin).

What are Oral anticoagulants (acitrom or warfarin)?

Oral anticoagulants (acitrom or warfarin) are the drugs given to patients when chances of complications related to blood clots are very high. Here are a few clinical conditions where the tendency to form blood clots is very high:

a. Artificial Heart Valve

b. Atrial fibrillation

c. Deep vein thrombosis

d. Pulmonary embolism.

e.And many more..

What is INR?

Once you are on oral anticoagulants (acitrom or warfarin) your heart specialist may repeatedly ask you to undergo a blood test known as INR.

INR is a test that measures how thin your blood is. Higher is the INR thinner is your blood.

In other words, if INR is low, there is a need to increase the dose of the drug and if INR is high, there is a need to decrease the dose of the drug.

https://www.youtube.com/embed/jx-plJ523kk?feature=oembedEducational Video for group of patient who are on acitrom and warfarin.

What should be my INR?

In most conditions, the target INR is 2.0-3.0. However, there are conditions where your heart specialist may wish to keep your INR between 2.5-3.5. Ask your heart specialist about your disease and target INR.

Target INR is 2.0-3.0 in most cases and 2.5-3.5 in some special cases.

What is Vitamin K and why it is important to me?

Vitamin K is a nutrient found in many vegetables and fruits. Vitamin K helps in blood clot formation by activating some factors at the time of injury. In other words, Vitamin K acts opposite to oral anticoagulants (acitrom or warfarin).

Vitamin K acts just opposite to the oral anticoagulants (acitrom or warfarin).

Excessive consumption of Vitamin K will decrease the effect of oral anticoagulants (acitrom or warfarin), thus putting you at risk of thrombosis. Consuming a diet low in Vitamin K will accentuate the effect of oral anticoagulants (acitrom or warfarin), thus putting you at risk of bleeding.

Keep an eye on the intake of Vitamin K. Target 90 micrograms’ daily consumption for females and 120 micrograms for males.

Dietary precautions with oral anticoagulants (acitrom or warfarin)

1. Keep a check on Vitamin K. Target 90 micrograms’ daily consumption for females and 120 micrograms for males. Variation in intake of Vitamin K will result in a variation in INR.
2. The higher is vitamin K, the lower will be INR. Consuming almost the same amount of vitamin K will help your doctor to achieve a stable INR.
3. Try to learn food items that are very high in Vit K (a few you consume frequently). A list of common food items has been given below.
4. Avoid items that are very high in Vitamin K.( In Indian Scenario-Bandh Gobhi/Saarso ka Saag/Paalak/Phool gobhi etc.) This will lower the INR.
5. Learn items that contain a moderate amount of Vitamin K( tomato, pea, ladyfinger there, etc.). You may consume a fixed amount of these items. Let’s take the example of tomatoes. If you take two tomatoes daily, try to stay at two only. Excessive consumption in the form of sauce, etc. will result in sudden Vit K fluctuation in your body and lower the INR.

What should be my diet with Oral anticoagulants (acitrom or warfarin)

Cabbage/Kale-AVOID THIS FOOD ITEM

Green Mustard(Saarson)-AVOID THIS FOOD ITEM

Spinach(Palak)-AVOID THIS FOOD ITEM

Ladyfinger( Bhindi)-CONSUME IN LIMITED AMOUNT

Tomato-CONSUME IN LIMITED AMOUNT

Cucumber( Kheera)-CONSUME IN LIMITED AMOUNTGreen Peas (Matar)-CONSUME IN LIMITED AMOUNT

Kiwi-CONSUME IN LIMITED AMOUNTJuice-Pomegranton/Orage/Cranberries-CONSUME IN LIMITED AMOUNT/BLEEDING RISK

Alcohol-CONSUME IN LIMITED AMOUNTChicken-CONSUME IN LIMITED AMOUNTBeef-CONSUME IN LIMITED AMOUNTLegumes-CONSUME HAPPILYDairy Product-CONSUME HAPPILY

High Vitamin K

Beef liver, broccoli, Brussels sprouts, cabbage, collard greens, endive, kale, lettuce, mustard greens, parsley, soy beans, spinach, Swiss chard, turnip greens, watercress, and other green leafy vegetables.

Moderate to high levels

Asparagus, avocados, dill pickles, green peas, green tea, canola oil, margarine, mayonnaise, olive oil, and soybean oil.

Food without Vit K but increase bleeding with warf/acitrom if consumed in large quantity

Cranberry juice, mangos, grapefruit, grapefruit juice, grapefruit seed extract, or pomegranate juice. Consuming these food items may result in bleeding. So avoid using these while you are on oral anticoagulants.

10 things you should take care of while on Oral anticoagulants (acitrom or warfarin)

1. Never skip oral anticoagulants (acitrom or warfarin) unless instructed by experts.
2. Don’t substitute one oral anticoagulant with others. (Warf to acitrom or acitrom to warf).
3. Keep INR in the target range appropriate for your illness.
4. Make a proper schedule of INR checking.
5. Learn how to self adjust the dose of oral anticoagulants (acitrom or warfarin)
6. Keep a check on Vitamin K. Target 90 micrograms’ daily consumption for females and 120 micrograms for males. Variation (underconsumption or overconsumption) in the intake of Vitamin K will result in a variation in INR.
7. Save yourself from injury. Bleeding from the injury site may take more time than normal to stop. Also, excessive bleeding may be detrimental to your heart.
8. Take care of your teeth. Unnoticeable bleeding from unhealthy gums may be detrimental to your heart.
9. Avoid heavy sports.
10. Always consult a heart specialist before undergoing surgery.

What precaution, do I need at the time of surgery?

1. You may require surgery because of one or other reasons.
2. Consult your heart specialist before undergoing surgery. This may require fresh echocardiogram and INR value. If feel, your heart specialist may change your OAC to more safer drug. This will be done to balance the risk of clot formation in absence of OAC and bleeding at the time of surgery.

How to self adjust dosage of oral anticoagulants (acitrom or warfarin?

Can I consume alcohol while on oral anticoagulants (acitrom or warfarin)?

Alcohol may increase the chance of major bleeding if you are on oral anticoagulants (acitrom or warfarin).

Pregnancy and Oral Anticoagulant/Acitrom

Oral anticoagulants (acitrom or warfarin) affects both fetus as well as the mother. Pregnancy may get difficulties either because of the adverse effect of drugs on the fetus, excessive bleeding during delivery, or due to underlying heart disease for which these oral anticoagulants (acitrom or warfarin) have been prescribed. Consult your heart specialist as soon as you are confirmed of pregnancy.