Patients on Anti-Coagulants – Be Careful of What You Drink

Many heart patients are routinely placed on anti-coagulants. Anti-coagulants help keep blood thin and flowing freely through veins and arteries; decreasing the risk of heart attack and stroke. Heart patients with Atrial Fibrillation (AF), in particular, are advised to take anti-coagulants.

Atrial fibrillation is the most common type of persistent, irregular heartbeat (cardiac arrhythmia). In atrial fibrillation, the heart’s upper chambers beat irregularly, affecting blood flow to the heart muscle and to the rest of the body. It increases the patient’s risk of blood clots, which can cause strokes and what is known as TIA (transient ischemic attack). TIA is what most people refer to as a “mini-stroke”, in which the patient suffers the effects of a stroke, but only for the short term.

For patients with AF, the heart beat may return to normal on its own, or the doctor may use electrical shock to get the heart back into its normal rhythm. Some patients, however, do not respond to this therapy, and require anti-coagulants to prevent stroke and other complications. In addition to AF, other heart problems may also require treatment with anti-coagulants.

Some doctors prescribe an aspirin each day for its blood thinning and anti-coagulant effects, but some patients require something stronger than the simple aspirin. For these patients, there are many prescription anti-coagulants and blood thinners from which doctors choose.

Anti-coagulants do have side effects; the most prevalent of which is the inability of your blood to properly clot in the event of surgery, or other bleeding. It is, therefore, very important to inform your doctors that you are on anti-coagulants, and to stop taking them before you have surgery. In addition, anti-coagulants may interact negatively with other medications and cause complications.

The most common anti-coagulant is warfarin, also known as coumadin. If your doctor prescribes warfarin, you should carefully follow all the recommendations that go along with warfarin, including having a thorough understanding of all the interactions. The most important things you should know about warfarin include:

o You should not become pregnant while taking warfarin. Be certain that you’re using a reliable form of birth control while taking this medicine. If you become pregnant while taking this medicine, let your doctor know immediately. Warfarin can cause birth defects.

o You must temporarily stop taking warfarin if you require any sort of surgery, including a spinal tap.

o Do not take warfarin in combination with aspirin or NSAIDs, (non-steroidal anti-inflammatory drugs) unless your doctor advises you that it’s ok. NSAIDs include ibuprofen, naproxen, celecoxib, and diclofenac. Even our very common over the counter pain relievers like motrin and advil are ibuprofen, and can cause serious interactions with warfarin. Serious bleeding in your stomach and intestines can result when you combine warfarin and these drugs.

o Watch what you eat and drink. This may be the most surprising consideration for patients who take warfarin. Many patients have no idea that their diet can significantly affect how warfarin works for them.

Dietary Concerns for Patients of Warfarin

Warfarin can be seriously affected by the amount of vitamin K in your diet. And, vitamin K is in many of the foods that we eat in large amounts, including the following:

o liver

o broccoli

o brussels sprouts

o spinach

o Swiss chard

o Coriander

o Collards

o Cabbage

o other green leafy vegetables

Even green tea, which has received rave reviews lately for its health benefits, can have a negative interaction with warfarin because of its vitamin K level. This is important for patients to understand, because many people have begun to drink green tea for its health benefits, particularly for those with heart problems.

The reason that green tea has been recommended for heart patients is because it has been shown to be effective in lowering LDL cholesterol (the bad cholesterol that clogs our arteries). In addition, green tea inhibits the formation of abnormal blood clots, which are the leading cause of heart attacks and strokes. So, we have begun to think of green tea as a healthy beverage for people who have heart disease or may be genetically predisposed to heart disease.

However, we now know that those heart patients who are taking warfarin for its anti-coagulation benefits should not drink green tea – or at least should not do so without permission from their doctor.

One compelling piece of information was discovered by the Department of Pharmacy Practice at the University of Florida. One patient receiving warfarin after having a mechanical valve replacement in his aorta, was progressing well with the warfarin treatment. However, his body’s absorption of the drug suddenly changed.

Within one week, the patient’s absorption of the warfarin dropped dramatically. Upon examination of the patient’s diet, it was discovered that he had recently begun to drink about one half to one gallon of green tea per day. Once the patient stopped drinking the green tea, his absorption of the warfarin began to return to normal.

Many people do not recognize that green tea is a significant source of vitamin K, so even if patients have been advised to avoid foods rich in vitamin K, they may not realize that green tea falls into this category.

So, if you’re a heart patient, be sure to talk to your doctor about green tea. Green tea contains many healthful benefits, and can be particularly healthy for heart patients. However, if you’re a heart patient who has been prescribed warfarin, green tea could significantly reduce the absorption of your medication.

If you’d like to drink green tea for its health benefits, your doctor may be able to advise you on a quantity that would be acceptable along with your warfarin.