Interní Med. 2011; 13(11): 431-435

Warfarin therapy management - myths and facts

MUDr.Ondřej Moravec, MUDr.Martin Hutyra, Ph.D., MUDr.Tomáš Skála, Ph.D., doc.MUDr.Miloš Táborský, CSc., FESC, MBA
I. interní klinika &ndash, kardiologická, LF UP a FN Olomouc

Oral anticoagulant therapy has become a cornestone in many internal cases. As the population as a whole is aging, the number of

patients who need warfarin is likewise increasing. The main problem of this therapy is due to the difficulty in determining the correct

dosage of the drug to obtain effective anticoagulation. Altough there are miscellaneous reasons for this variability a great emphasis is

often incorrectly placed on food interaction. The article provides an overview of several possible causes of interindividual variability in

warfarin dose and their clinical importance.

Keywords: warfarin, drug interactions, diet, vitamin K

Published: November 1, 2011  Show citation

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Moravec O, Hutyra M, Skála T, Táborský M. Warfarin therapy management - myths and facts. Interní Med. 2011;13(11):431-435.
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    References

    1. Mahaffey K. Rivaroxaban Once-Daily Oral Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation. Presented at the American Heart Association Scientific Sessions, Chicago, IL, November 15, 2010.
    2. Wallentin L, Yusuf S, Ezekowitz MD, on behalf of the RELY investigators. Efficacy and safety of dabigatran compared with warfarin at different levels of international normalised ratio control for stroke prevention in atrial fibrillation: an analysis of the RE-LY trial. Lancet 2010; 376: 975-983. Go to original source... Go to PubMed...
    3. Attay JK, Flumara K, Piazza G. Cost analyzis of substituting Dabigatran for Warfarin, Poster, ACC's 60th Annual Scientific Sessions 2011.
    4. Link KP. The discovery of dicumarol and its sequels. Circulation 1959, 19(1): 97-107. Go to original source... Go to PubMed...
    5. United States Occupational Safety and Health Administration (OSHA) (16 August 1996). Documentation for Immediately Dangerous To Life or Health Concentrations (IDLHs): Warfarin. Centers for Disease Control and Prevention. Retrieved 7 July 2008.
    6. Whitlon DS, Sadowski JA, Suttie JW. Mechanism of coumarin action: significance of vitamin K epoxide reductase inhibition. Biochemistry 1978, 17(8): 1371-1377. Go to original source... Go to PubMed...
    7. Product information: Coumadin (warfarin). Princeton, NJ: Bristol-Myers Squibb Co. (2010).
    8. Nutescu EA, Shapiro NL, Chevalier A, Amin AN. A pharmacologic overview of current and emerging anticoagulants. Cleve. Clin. J. Med. 2005, 72(Suppl 1): S2-S6. Go to original source... Go to PubMed...
    9. Sanderson S, Emery J, Higgins J. CYP2C9 gene variants, drug dose, and bleeding risk in warfarin-treated patients: A HuGEnet(TM) systemic review and meta-analysis. Genet Med. 2005; 7: 97-104. Go to original source... Go to PubMed...
    10. Wadelius M, Chen LY, Downes K, et al. Common VKORC1 and GGCX polymorphisms associated with warfarin dose. Pharmacogenomics J. 2005; 5: 262-270. Go to original source... Go to PubMed...
    11. Demirkan K, Stephens MA, Newman KP, Self TH. Response to Warfarin and Other Oral Anticoagulants: Effects of Disease States. South Med J 2000; 93(5): 448-455. Go to original source... Go to PubMed...
    12. Holbrook AM, Wells PS, Crowther NR. Pharmacokinetics and drug interactions with warfarin. In: Poller L, Hirsh J (eds.). Oral anticoagulants. Dunton Green, England: Hodder and Stoughton; 1996.
    13. Holbrook AM, Pereira JA, Labiris R, et al. Systematic overview of Warfarin and its drug and food interactions. Arch Intern Med 2005; 165: 1095-1106. Go to original source... Go to PubMed...
    14. Dieta při léčbě orálními antikoagulancii. Farmakoterapeutické informace 2011, 3: 2-3.
    15. Sconce E, Khan T, Mason J, et al. Patients with unstable control have a poorer dietary intake of vitamin K compared to patiens with stable control of anticoagulation. ThrombHaemost 2005; 93: 872-875. Go to original source...
    16. Lefflerová K. Úskalí antikoagulační léčby Warfarinem u nemocných s fibrilací síní - lékové a potravinové interakce. Interv Akut Kardiol 2008; 7(6): 220-224.
    17. Booth SL, Charnley JM, Sadowski JA, et al. Dietary vitamin K1 and stability of oral anticoagulation: Proposal of a diet with constant vitamin K1 content. Thromb Haemost 1997; 77(3): 504-509. Go to original source... Go to PubMed...
    18. Franco V, Polanczyk CA, Clausell N, Rohde LE. Role of dietary vitamin K intake in chronic oral anticoagulation: prospective evidence from observational and randomized protocols. Am. J. Med. 2004; 116: 651-656. Go to original source... Go to PubMed...
    19. Nutescu EA, Shapiro LN, Ibrahim S, West P. Warfarin and its interactions with foods, herbs and other dietary supplements. Expert Opin Drug Saf 2006, 5(3): 433-451. Go to original source... Go to PubMed...
    20. Sullivan DM, Ford MA, Boyden TW. Grapefruit juice and the response to warfarin. Am. J. Health Syst. Pharm. 1998, 55: 1581-1583. Go to original source... Go to PubMed...
    21. Nutescu EA, Chuatrisorn I, Hellenbart E. Drug and dietary interactions of warfarin and novel oral anticoagulants: an update J Thromb Thrombolysis 2011; 31: 326-343. Go to original source... Go to PubMed...
    22. Macan H, Uykimpang R, Alconcel M, et al. Aged garlic extract may be safe for patients on warfarin therapy. J. Nutr. 2006; 136: 793S-795S. Go to original source... Go to PubMed...
    23. Matýšková M. Warfarin, potrava a potravinové doplňky. Interni Med. 2010; 12(2): 87-91.
    24. Ryšavá L. Omezovat konzumaci zeleniny při lečbě warfarinem a etylbiskumacetatem? Interni Med. 2008; 10(12): 581-582.
    25. Karetová D, Bultas J. Dlouhodobá antikoagulační léčba dnes a v blízké perspektivě. Postgrad Med, 2006; 8(4): 429-434.
    26. The ACTIVE Investigators. Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events (ACTIVE W): A randomised controlled trial. Lancet 2006; 367: 1903-1912. Go to original source... Go to PubMed...
    27. Connolly SJ, Ezekowitz MD, Yusuf S. Dabigatran versus Warfarin in Patients with Atrial Fibrillation. N Engl J Med 2009 Aug 30. Go to original source... Go to PubMed...
    28. Halperin JL. Ximelagatran compared with warfarin for prevention of thromboembolism in patients with nonvalvular atrial fibrillation: Rationale, objectives, and design of a pair of clinical studies and baseline patient characteristics (SPORTIF III and V). Am Heart J 2003; 146: 431-438. Go to original source... Go to PubMed...
    29. Stangier J. Clinical pharmacokinetics and pharmacodynamics of the oral direct thrombin inhibitor dabigatran etexilate. Clin Pharmacokinet 2008; 47(5): 285-295. Go to original source... Go to PubMed...

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