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Genetic Testing Improves Coumadin Dosing

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The anticoagulant warfarin, also known as Coumadin, is notoriously difficult to use. On the one hand, it saves lives by preventing lethal blood clots. On the other, though, getting the dose right can be tricky. There is a genetic test to help guide doctors in determining the appropriate dose. The question has been whether the results make enough practical difference to justify the cost of $250 to $400. Mayo Clinic scientists tested nearly 900 patients. They were compared to almost 2,700 patients who were not tested. In the course of six months, 18 percent of the tested patients had drug complications, compared to 26 percent of the untested controls. The savings in hospitalization costs more than made up for the cost of the initial genetic testing.

[ Meeting of the American College of Cardiology, March, 2010]

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6 Comments

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I have been using warfarin for several years because of artrial fibrillation. My INR is checked approximately every 3-4 weeks, and has never presented a problem. The desired range is between 2.0 and 3.0 and achieving that is not a problem although at times my INR might be a 1.8 or a 3.1.

My understanding is that the main problems with taking warfarin is not so much the medication, but the participatory behavior of the patient. Lack of patient compliance is a major factor; they often to not take the drug on a regular basis as they should, and the effect of the drug is dependent on diet, eg. too much Vitamin K (especially as in spinach) will inhibit the drug's actions and efficacy, and the drug will not be a effective as it could be in preventing blood clots.

Too much warfarin can lead to excessive bleeding, both internally and externally. The desired range of 2.0 to 3.0 allows for variabilities of factors of daily living. IF PATIENTS WOULD FOLLOW THE DIRECTIONS AND DOCTORS' INSTRUCTIONS CLOSELY AND CONSISTENTLY, there would be relatively few, if any, problems.

I have a long history of heart disease through my maternal side of the family. I was diagnosed with hypertension over 30 years ago and began treatment. Ten years ago I had a heart attack and had open heart surgery. I received an aortic valve and was prescribed COUMADIN along with a BETA BLOCKER and an ACE INHIBITOR. In my opinion and that of my cardiologist, COUMADIN/WARFARIN has been very beneficial in helping control my condition with very little dosage adjustments since the onset.

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I was prescribed warfarin over 18 months ago. I was diagnosed with atrial fib, and have an older brother and father (deceased) who suffered with major strokes. I have usually been within the limits (2.0-3.0 tested monthly). The dosage adjustments, when necessary, have ranged from 6 days of 2.5 (half pill) and 1 day of 5.0 (whole pill) to 5 days of 2.5 to 2 days of 5.0. I have never experienced bleeding, but I worry whether I may have any unexplained side effects. My other scrips include Atacand, Flomax, Vytorin, and Digoxin.

I would appreciate it if you are aware of any side effects triggered by this
combination of scrips. Thanks much!

PEOPLE'S PHARMACY RESPONSE: BOTH FLOMAX AND VYTORIN CAN ALTER THE BODY'S RESPONSE TO WARFARIN, SO YOU WILL NEED TO STAY AS VIGILANT AS YOU HAVE BEEN. IF YOU STOP TAKING EITHER OF THEM, THE DOCTOR MIGHT NEED TO ADJUST THE DOSE OF WARFARIN.

I have atrial fibrillation for which my cardiologist has recommended that I go on a prescription blood thinner (coumadin or pradoxa). I would prefer a natural remedy. Are there any foods or supplements that would act to thin the blood and reduce the danger of stroke? If the answer is "no" and drugs are the only way to go, would Pradoxa be a better alternative than coumadin (aside from the obvious cost difference)?

PEOPLE'S PHARMACY RESPONSE: NATURAL BLOODTHINNERS ARE NOT RELIABLE ENOUGH.

THE STUDIES SHOW THAT PRADAXA AND COUMADIN BOTH WORK ABOUT EQUALLY WELL. PRADAXA IS EASIER TO MANAGE, THOUGH, SINCE IT DOESN'T NEED MONITORING OR DIETARY CAUTION.

I would like a complete list of forbidden foods when you are on coumadin. I know about the k's, but are there any others I should be aware of?
Thank you

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