I. Coumadin fact file

Coumadin is manufactured by Bristol-Myers Squibb.

Bristol-Myers Squibb is one of the world's leading makers of medicines and related health care products.

Bristol-Myers Squibb is one of 20 U.S. companies listed in the new Global 100 Most Sustainable Corporations in the World. The new global business ranking identifies the top 100 companies that are most open to leading the way to a more sustainable world.

II. Coumadin Medication

Coumadin is an anticoagulant drug. It is only available by prescription, and should only be taken under the supervision of a physician familiar with its indications and actions.

Coumadin is based on a chemical known as warfarin sodium. Coumadin (warfarin) causes its anti-clotting effect by impairing the production of certain blood clotting proteins by the liver. These proteins, called "cofactors" are necessary elements of a complex series of proteins which the body uses to form a solid clot. The proteins are the fundamental components of the "intrinsic pathway" of clotting, in which many other proteins participate in concert.

The specific action of Coumadin is to block the production of Factors VII, IX, X, and II by the liver. Creation of these factors by the liver is normally controlled by Vitamin K. This dietary vitamin is ingested with many different green vegetables. In addition, vitamin K can be produced by bacteria in the large intestine. As it is absorbed from the intestinal tract, Vitamin K is absorbed by, and stored in, the liver. Subsequently vitamin K is used in a vital regulatory step during the production of clotting Factors VII, IX, X, and II by the liver.

Administration of Coumadin (warfarin) sodium blocks the action of vitamin K within the liver. Coumadin effectively competes for the same absorption sites within the liver needed for vitamin K uptake. Thus the levels of vitamin K within the liver decrease. Reduced amounts of clotting factors VII, IX, X, and II are produced, and the clotting action of the blood is progressively impaired.

All of the actions of Coumadin are due to the drugs inhibition of vitamin K. Thus ingestion or administration of vitamin K can reverse the effects of Coumadin. In fact, clinical overdosage with Coumadin is corrected with vitamin K. Dietary intake of vitamin K does affect the metabolism of Coumadin. This is one of the reasons that each patient seems to require a different dose of the drug to reach the target anticoagulation effect. Each person has different dietary intake of vitamin K, and also different liver function, different excretion of the drug, etc. Thus it is important for the physician to have a monitor of the Coumadin effect on the patients clotting mechanism. Without a monitor, patients would frequently be overdosed or underdoses, with potentially hazardous consequences.

Monitoring of the Coumadin effect is performed with a blood test. This test is known as the Prothrombin Time or P.T.. In recent years, the P.T. has been supplanted by the INR, or International Normalized Ratio. The INR is a more accurate way to calibrate the results of a prothrombin time test.

Coumadin: Dietary concerns

Coumadin acts by impairing the utilization of Vitamin K. The liver requires Vitamin K for the manufacturing of certain key proteins in the native clotting mechanism. When Vitamin K is not made available, these clotting factors are not manufactured, and blood clotting is impaired.

At the same time, oral intake of Vitamin K will thus counteract the medicinal purpose of Coumadin, essentially acting as the antidote for Coumadin. Sudden intake of large amounts of Vitamin K can diminsh the effect of Coumadin, permitting the blood to clot. Some physicians place Coumadin patients on strict Low-Vitamin-K diets.

Foods that are high in Vitamin K are discouraged.

However, dietary restrictions rarely succeed over a long period of time. Most patients return to eating their favorite foods, gradually at first. Thus the more prudent approach for Coumadin maintenance is to adjust the medication, not the diet. That is one of the very reasons for repeating the Pro-Time until a steady dose is found that provides the right anticoagulation regardless of the dietary intake of the patient.

For your information, the following lists presents foods known to be high in Vitamin K

Kale
Spinach
Broccoli
Cauliflower
Turnip Greens
Chick Peas
Brussels sprouts
Green tea
Soybean oil
beef, pork, or chicken livers
soy protein products (including Tofu)
vitamins A & E (large doses)
If your regular diet already contains these food items, Don't Change Your Eating Habits.

Consistency in your daily eating pattern is the key. If you move to a new climate, or change your eating habits for any other reason, a new series of Pro-Times will be needed to make certain that your Coumadin requirement has not changed. However, even if it has changed, the best option is to change the dose which you take.

Anti-coagulants: Information

An anticoagulant (an"tih-ko-AG'u-lant) is a drug that helps prevent the clotting (coagulation) of blood. These drugs tend to prevent new clots from forming or an existing clot from enlarging. They don't dissolve a blood clot. Anticoagulants are also given to certain people at risk for forming blood clots, such as those with artificial heart valves or who have atrial fibrillation (A'tre-al fib"rih-LA'shun).

A common type of stroke is caused by a blood clot blocking blood flow to the brain. To prevent such clots, anticoagulants are often prescribed for people with conditions such as atrial fibrillation to prevent a first or recurrent stroke.

The most widely used oral anticoagulant (and one of the most commonly prescribed medications) in the Western World is warfarin (also known by the trade name of Coumadin). This unique medication does only one thing. It reduces the tendency of the blood to clot. There are millions of patients worldwide safely taking Coumadin. However, the unique action and metabolism of Coumadin requires careful dosing, adminstration and follow-up.

Heparin (HEP'ah-rin) and warfarin, a derivative of coumarin (KOO'mah-rin), are examples of anticoagulants.

Coagulation: Information

Process of clotting
The circulatory system has to be self-sealing, otherwise continued blood loss from even the smallest injury would be life threatening. Normally, all but the most catastrophic bleeding is rapidly stopped, a process known as hemostasis. This process occurs through a progression of several steps.

Hemostasis is a combination of events that occur due to physical and chemical forces. The initial steps lead to a reduction in the blood flow due to the formation of a cellular plug. The later steps utilize chemical energy to form a blood clot, medically known as thrombus.

The aggregating platelets and the damaged tissue initiate the biochemical process of blood clotting or coagulation, the body's major defense against blood loss.

Side effects of Anti-coagulants

A side effect common to all anticoagulants is the risk of excessive bleeding (haemorrhages), due to the blood being thinned. This is why people taking anticoagulants should be closely monitored to check that they are on the correct dosage of their drug. The most common test is the INR. Patients should also be aware that any shortness of breath, light-headedness, or racing heart beat is an associated complication with their condition. One should contact his/her physician immediately should such episodes occur.

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III. Useful links

Government

http://www.cdc.gov/

http://www.fda.gov/

http://www.fda.gov/cder/ogd/

http://www.nih.gov/

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi

http://www.health.gov.on.ca/

National Library of Medicine

World Health Organization

http://www.mayoclinic.com/index.cfm

MedicineNet.com

Drugdigest.org

Healthsquare.com

Pharmacy sites

http://www.bms.com/landing/data/index.html

http://www.hsforum.com/stories/storyReader$1509 ,

http://www.hsforum.com/stories/storyReader$1516

http://www.hsforum.com/stories/storyReader$1504,

http://www.people.vcu.edu/~urdesai/atc.htm#Process%20of%20clotting

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