Risk of Warfarin‐Related Bleeding Events and Supratherapeutic International Normalized Ratios Associated with Complementary and Alternative Medicine: A Longitudinal Analysis

  title={Risk of Warfarin‐Related Bleeding Events and Supratherapeutic International Normalized Ratios Associated with Complementary and Alternative Medicine: A Longitudinal Analysis},
  author={Stephen J Shalansky and Larry D. Lynd and Kathryn Richardson and Andrew Ingaszewski and Charles Kerr},
  journal={Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy},
Study Objective. To determine the risk of bleeding and supratherapeutic international normalized ratios (INRs) associated with use of complementary and alternative medicine (CAM) in patients receiving warfarin. 
Bleeding with Direct Oral Anticoagulants vs Warfarin: Clinical Experience.
Bleeding with direct oral anticoagulants vs warfarin: clinical experience.
Warfarin Drug Interactions
Warfarin has FDA approval for the prophylaxis and treatment of venous thrombosis and its complications, and as an adjunct to reduce the risk of myocardial infarction (MI) and other thromboembolic events in high-risk patients.
Factors Influencing Concomitant Use of Complementary and Alternative Medicines with Warfarin
To investigate factors influencing complementary and alternative medicines (CAM) use among patients on warfarin, a data collection and analysis project was conducted at the National Institutes of Health.
Influence of kidney function on risk of supratherapeutic international normalized ratio-related hemorrhage in warfarin users: a prospective cohort study.
  • N. Limdi, T. Nolin, T. Beasley
  • Medicine
    American journal of kidney diseases : the official journal of the National Kidney Foundation
  • 2015
Patients with lower eGFRs have differentially higher hemorrhage risk at INR ≥ 4, and because the INR reversal rate is slower, hemorrhagerisk is prolonged.
Intensity of Anticoagulation with Warfarin and Risk of Adverse Events in Patients Presenting to the Emergency Department
By establishing the impact of warfarin-related adverse events in this population, focused interventions can be established in this setting to address factors that can be targeted to reduce these events.
Prescribing warfarin appropriately to meet patient safety goals.
The anticoagulant warfarin is increasingly used in a variety of disorders associated with risk of thromboembolism. The drug is undoubtedly effective but is linked to numerous nutrient, disease, and
Evaluation of documented drug interactions and contraindications associated with herbs and dietary supplements: a systematic literature review
This review aims to evaluate the documented HDS‐drug interactions and contraindications.
Patient Factors That Influence Warfarin Dose Response
  • P. White
  • Medicine
    Journal of pharmacy practice
  • 2010
This review will examine specific clinical factors that can affect the pharmacokinetics and pharmacodynamics of warfarin, as well as the role of pharmacogenetics in optimizingwarfarin therapy.
Effects of Oral Ginger Supplementation on the INR
A brief case report discusses the potential scope of the problem as well as the proposed pharmacokinetic and pharmacodynamic interactions between these two commonly used agents, warfarin and ginger.


Effect of vitamin E on the anticoagulant response to warfarin.
Diarrhea-associated over-anticoagulation in a patient taking warfarin: therapeutic role of cholestyramine.
Cholestyramine was utilized to interrupt the enterohepatic recycling of warfarin and for its antidiarrheal effects to prevent gastrointestinal vitamin K wasting and attainment of a therapeutic International Normalized Ratio in 39 h.
Frequency and Causes of Overanticoagulation and Underanticoagulation in Patients Treated with Warfarin
To determine the frequency and the specific causes of over‐and underanticoagulation in patients who receive warfarin therapy and are managed in an anticoagulant clinic.
Enhanced Antithrombotic Effect of Warfarin Associated with Low‐Dose Alcohol Consumption
Caution should be used whenever warfarin and alcohol in any amount are taken together, especially in patients receiving many drugs, and close monitoring of the INR is warranted.
Acetaminophen and other risk factors for excessive warfarin anticoagulation.
The data suggest that acetaminophen is an underrecognized cause of overanticoagulation in the outpatient setting, and increased monitoring of INR values when such risk factors are present or modification of the risk factors themselves should reduce the frequency of dangerously high levels of anticoagulations.
Bleeding risks of antithrombotic therapy
No significant associations of anticoagulant control were found with age, sex, social circumstances, mobility, domicillary supervision of medication, or indications for antICOagulation in elderly people.
Hemorrhagic complications of anticoagulant treatment: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.
There is good evidence that vitamin K antagonist therapy, targeted international normalized ratio (INR) of 2.5 (range, 2.0 to 3.0), is associated with a lower risk of bleeding than therapy targeted at an INR >3.0.
Effect of coenzyme Q10 and Ginkgo biloba on warfarin dosage in stable, long-term warfarin treated outpatients. A randomised, double blind, placebo-crossover trial.
Effect of Coenzyme Q10 and Ginkgo biloba on Warfarin Dosage in Stable, Long-term Warfarin Treated Outpatients. A Randomised, Double Blind, Placebo-crossover Trial -
A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke.
Over two years, a multicenter, double-blind, randomized trial found no difference between aspirin and warfarin in the prevention of recurrent ischemic stroke or death or in the rate of major hemorrhage.
The pharmacology and management of the vitamin K antagonists: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy.
The article describes the antithrombotic effect ofVKAs, the monitoring of anticoagulation intensity, the clinical applications of VKA therapy, and the optimal therapeutic range of VKAs, and provides specific management recommendations.