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What Are The Side Effects Of Warfarin Drug?
Question: My husband had one incidence of afib probably because he was dehydrated. We monitored his heart for a few weeks and he had no other incidences. The dr. said he wanted him on Wafarin, but I said one incident doesn't justify that. Also, because he is 75, he may have brain microbleeds. He takes DHA, flax, vitamin E and other things that might thin the blood. What is it exactly that aspirin does that is good for thinning the blood and how do you measure it? Is it INR? I don't want him to start aspirin therapy if we are already accomplishing blood thinning by other means.
Brief Answer:
First define exactly the need for anticoagulation.
Detailed Answer:
Hello! Thank you for your question on HCM! I understand your concern and would like to explain that regarding anticoagulation with warfarin it is recommended in atrial fibrillation patients when thrre is a high risk for stroke and thrombo-embolism. This is easily defined by you doctor using CHAD2DS2VASc score. If score is greater than 2 the patient should be treated with anticoagulation. If lower than 2 aspirin could be an option (aspirin exerts antithrombotic effect which is measured by aggregometry test).
The problem when using warfarin is the need for periodically dosing its effect by INR.
To overcome annoying INR, new oral anticoagulants may be an option (rivaroxaban, etc) . DHA, flax and vitamin E don't exert any therapeutic anticoagulation effects, so are not an alternative of any anticoagulation.
To conclude, first should be defined the necessary indication for anticoagulation and also the normal synthetic status of the transplanted liver (native INR); after that comes the discussion for drug choices.
Hope to have been helpful to you! Feel free to ask me whenever you need! Best wishes! Dr. Iliri
First define exactly the need for anticoagulation.
Detailed Answer:
Hello! Thank you for your question on HCM! I understand your concern and would like to explain that regarding anticoagulation with warfarin it is recommended in atrial fibrillation patients when thrre is a high risk for stroke and thrombo-embolism. This is easily defined by you doctor using CHAD2DS2VASc score. If score is greater than 2 the patient should be treated with anticoagulation. If lower than 2 aspirin could be an option (aspirin exerts antithrombotic effect which is measured by aggregometry test).
The problem when using warfarin is the need for periodically dosing its effect by INR.
To overcome annoying INR, new oral anticoagulants may be an option (rivaroxaban, etc) . DHA, flax and vitamin E don't exert any therapeutic anticoagulation effects, so are not an alternative of any anticoagulation.
To conclude, first should be defined the necessary indication for anticoagulation and also the normal synthetic status of the transplanted liver (native INR); after that comes the discussion for drug choices.
Hope to have been helpful to you! Feel free to ask me whenever you need! Best wishes! Dr. Iliri
Above answer was peer-reviewed by :
Dr. Pradeep Vitta
1. What exactly is the result from using aspirin therapy. If it is used for anticoagulation, what is the measure of it's effectiveness? if it's blood-thinning, how is that measured? If INR is the basis, what is the target INR?
2. If supplements don't have any therapeutic effects, why do they tell you to stop using them before surgical procedures?
3. He had high homocysteine (due to mthfr defect), and it was lowered using a combo of folate and B12. This should also reduce his risk of clotting. Your thoughts on MTHFR?
2. If supplements don't have any therapeutic effects, why do they tell you to stop using them before surgical procedures?
3. He had high homocysteine (due to mthfr defect), and it was lowered using a combo of folate and B12. This should also reduce his risk of clotting. Your thoughts on MTHFR?
Brief Answer:
Talk to the doctor about thrombotic risk score.
Detailed Answer:
Hello again dear! It seems that we have two questions to resolve now: a) atrial fibrillation and b) elevated homocysteine.. As I said to you when the matter is to choose between aspirin and warfarin we look for help on CAD2DS2VASc score (consult Web or takk to the doctor about score variables ). Ii score greater than 2 we recommend warfsrin, if lower than 2 we give aspirin. Now lets return to your questions.
(1) Aspirin is an antiagregant not an anticoagulant. When used its effect is measured by optical aggregometry test, not INR. Warfarin effect is measured by INR ( its therapeutic ranges between 2 to 3.5). Aspirin produces an antithrombotic effect equal to using warfarin with INR lower than 1.8-1.9 (subtherapeutic). So aspirin is inferior to warfarin.
(2) Supplements like folate and B12 are effective in lowering high homocysteine levels, but they don't exert antithrombotic effects in therapeutic levels. Mesical litrrature doesn't refer to them as antithrombotics.
(3) Supplements are effective in llowering homocysteine levels and thus reducing the risk of clotting imposed by that. But the thrombotic risk of atrial fibrillation is an additive separated one and should be treated with the well - known evidence based antithronbotics.
Regarding MTHFR mutation if it is homozygous the risk for vein and arterial thrombosis remain high if homocysteine level is nnot lowered.
Greetings from Dr. Iliri
Talk to the doctor about thrombotic risk score.
Detailed Answer:
Hello again dear! It seems that we have two questions to resolve now: a) atrial fibrillation and b) elevated homocysteine.. As I said to you when the matter is to choose between aspirin and warfarin we look for help on CAD2DS2VASc score (consult Web or takk to the doctor about score variables ). Ii score greater than 2 we recommend warfsrin, if lower than 2 we give aspirin. Now lets return to your questions.
(1) Aspirin is an antiagregant not an anticoagulant. When used its effect is measured by optical aggregometry test, not INR. Warfarin effect is measured by INR ( its therapeutic ranges between 2 to 3.5). Aspirin produces an antithrombotic effect equal to using warfarin with INR lower than 1.8-1.9 (subtherapeutic). So aspirin is inferior to warfarin.
(2) Supplements like folate and B12 are effective in lowering high homocysteine levels, but they don't exert antithrombotic effects in therapeutic levels. Mesical litrrature doesn't refer to them as antithrombotics.
(3) Supplements are effective in llowering homocysteine levels and thus reducing the risk of clotting imposed by that. But the thrombotic risk of atrial fibrillation is an additive separated one and should be treated with the well - known evidence based antithronbotics.
Regarding MTHFR mutation if it is homozygous the risk for vein and arterial thrombosis remain high if homocysteine level is nnot lowered.
Greetings from Dr. Iliri
Above answer was peer-reviewed by :
Dr. Prasad
Thank you for your response.
What if the score is 2? What if the pt. has microbleeds in the brain. Shouldn't the dr. check for this if the pt. has cognitive difficulties? Wouldn't it be dangerous if the pt had microbleeds to prescribe wafarin?
Thank you for the answer with regard to what asperin does.
With regard to lowering homocysteine, I have read that lowering homocysteine does not lower the risk that the elevated homocysteine. His hcy went from 17 to 11 with folate/B12 therapy and may be lower/normal by now. Why don't doctors test routinely for B12 levels and hcy if they have clear implications in heart and brain problems?
Where did you read that with regard to homozygous risk for DVT and AT? Homozygous for which mutation? He is compound heterozygous for 677 and 1298 MTHFR mutations.
Thank you.
What if the score is 2? What if the pt. has microbleeds in the brain. Shouldn't the dr. check for this if the pt. has cognitive difficulties? Wouldn't it be dangerous if the pt had microbleeds to prescribe wafarin?
Thank you for the answer with regard to what asperin does.
With regard to lowering homocysteine, I have read that lowering homocysteine does not lower the risk that the elevated homocysteine. His hcy went from 17 to 11 with folate/B12 therapy and may be lower/normal by now. Why don't doctors test routinely for B12 levels and hcy if they have clear implications in heart and brain problems?
Where did you read that with regard to homozygous risk for DVT and AT? Homozygous for which mutation? He is compound heterozygous for 677 and 1298 MTHFR mutations.
Thank you.
Brief Answer:
First we have to define clear indication or contra
Detailed Answer:
Hello! Regarding stroke risk score, cut off is 2 or greater (sorry about my cel symbol functioning) needs anticoagulation such as warfarin.
If the patient has cognitive difficulties the discussion changes: (1) at that age cognitive disorders are commonly present, but in order to exclude cerebral microbleeds a head CTscan or MRI is needed. (2) If severe cognitive impairment is present (with/without microbleeds) anticoagulation is not recommended because of bad medication compliance, elevated risk of head trauma, inability to follow anticoagulation level (INR), etc.
Regarding homocysteine it is classically known that prolonged exposure from high levels of homocysteine increase the risk of vascular endothelial damage, accelerated atherosclerosis, venous thrombosis. I am sorry about theoretical phrases, but regarding lowering homocysteine effect there are different study conclusions. But remains the fact that elevated homocysteine expresses a pro inflammatory and prothrombotic state. As homocysteine level is now 11 it is considered normal (lower than 13). Both B12 and homocysteine levels are tested when there is suspicion about any potential disorders and when available.
Regarding MTHFR gene mutation it is proven that a homozygous one (C677T or A1289C) or a combination of both is clinically more relevant regarding consequences.
I am sorry to limit my explanation here, as it would change to an academic discussion otherwise.
But to the end I want to assure you that the above is confirmed by clinical practice and studies.
My best wishes!
First we have to define clear indication or contra
Detailed Answer:
Hello! Regarding stroke risk score, cut off is 2 or greater (sorry about my cel symbol functioning) needs anticoagulation such as warfarin.
If the patient has cognitive difficulties the discussion changes: (1) at that age cognitive disorders are commonly present, but in order to exclude cerebral microbleeds a head CTscan or MRI is needed. (2) If severe cognitive impairment is present (with/without microbleeds) anticoagulation is not recommended because of bad medication compliance, elevated risk of head trauma, inability to follow anticoagulation level (INR), etc.
Regarding homocysteine it is classically known that prolonged exposure from high levels of homocysteine increase the risk of vascular endothelial damage, accelerated atherosclerosis, venous thrombosis. I am sorry about theoretical phrases, but regarding lowering homocysteine effect there are different study conclusions. But remains the fact that elevated homocysteine expresses a pro inflammatory and prothrombotic state. As homocysteine level is now 11 it is considered normal (lower than 13). Both B12 and homocysteine levels are tested when there is suspicion about any potential disorders and when available.
Regarding MTHFR gene mutation it is proven that a homozygous one (C677T or A1289C) or a combination of both is clinically more relevant regarding consequences.
I am sorry to limit my explanation here, as it would change to an academic discussion otherwise.
But to the end I want to assure you that the above is confirmed by clinical practice and studies.
My best wishes!
Note: Do you have more questions on diagnosis or treatment of blood disorders? Ask An Expert/ Specialist Now
Above answer was peer-reviewed by :
Dr. Prasad
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