warfarin and Diarrhea

The purpose of this review article is to summarize the literature on diseases that are documented to have an effect on response to warfarin and other VKAs.. We searched the English literature from 1946 to September 2015 via PubMed, EMBASE, and Scopus for the effect of diseases on response vitamin K antagonists including warfarin, acenocoumarol, phenprocoumon, and fluindione.. Among many factors modifying response to VKAs, several disease states are clinically relevant. Liver disease, hyperthyroidism, and CKD are well documented to increase response to VKAs. Decompensated heart failure, fever, and diarrhea may also elevate response to VKAs, but more study is needed. Hypothyroidism is associated with decreased effect of VKAs, and obese patients will likely require higher initial doses of VKAs.. In order to minimize risks with VKAs while ensuring efficacy, clinicians must be aware of the effect of disease states when prescribing these oral anticoagulants.

Topics: Acenocoumarol; Administration, Oral; Anticoagulants; Cardiovascular Diseases; Diarrhea; Fibrinolytic Agents; Heart Failure; Humans; Hyperthyroidism; Kidney Failure, Chronic; Liver Diseases; Obesity; Phenindione; Phenprocoumon; Vitamin K; Warfarin

Topics: Chamomile; Colic; Conjunctivitis; Cyclosporine; Dermatitis; Dermatitis, Contact; Diarrhea; Dyspepsia; Female; Flowers; Herb-Drug Interactions; Humans; Infant; Lactation; Morning Sickness; Phytotherapy; Plant Extracts; Plant Preparations; Pregnancy; Warfarin

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.. Prospective, longitudinal study.. An acute care, academic and research hospital in Canada.. A total of 171 adults who were prescribed warfarin anticoagulation therapy for an expected duration of at least 4 months after enrollment.. Patients were asked to complete a 16-week diary by recording bleeding events and exposure to factors previously reported to increase the risk of bleeding and supratherapeutic INRs, including CAM consumption.. Prescription, medical, and laboratory records were reviewed. Risk factors for bleeding events and supratherapeutic INR (at least 0.5 units above the target range) were evaluated longitudinally by using generalized estimating equation (GEE) modeling. Of the 171 patients completing a diary, 87 (51%) reported at least one bleeding event and 36 (21%) had a supratherapeutic INR. Seventy-three patients (43%) indicated they had used at least one CAM product previously reported to interact with warfarin. Warfarin use of less than 3 months' duration was the only statistically significant risk factor identified for supratherapeutic INR. The CAM therapies associated with an increased risk of self-reported bleeding included cayenne, ginger, willow bark, St. John's wort, and coenzyme Q(10). Use of more than one CAM while receiving warfarin was also a significant risk factor. Two CAMs were independently associated with an increased risk of self-reported bleeding: coenzyme Q(10) (odds ratio [OR] 3.69, 95% confidence interval [CI] 1.88-7.24) and ginger (OR 3.20, 95% CI 2.42-4.24). Other risk factors significantly associated with increased bleeding included high target INR (2.5-3.5), diarrhea, acetaminophen use, increased alcohol consumption, and increased age.. The use of CAM by patients receiving warfarin is common, and consumption of coenzyme Q(10) or ginger appears to increase the risk of bleeding in this population.

Topics: Acetaminophen; Adult; Age Factors; Aged; Aged, 80 and over; Anticoagulants; Canada; Coenzymes; Complementary Therapies; Diarrhea; Dietary Supplements; Drug Interactions; Ethanol; Female; Hemorrhage; Herb-Drug Interactions; Humans; International Normalized Ratio; Longitudinal Studies; Male; Middle Aged; Phytotherapy; Plants, Medicinal; Prospective Studies; Risk Factors; Ubiquinone; Vitamins; Warfarin; Zingiber officinale

Topics: Adult; Anti-Inflammatory Agents; Aspirin; Biphenyl Compounds; Blood Coagulation; Blood Urea Nitrogen; Chlorides; Clinical Trials as Topic; Constipation; Diarrhea; Digestive System; Drug Tolerance; Exanthema; Flatulence; Flufenamic Acid; Fluorine; Headache; Heartburn; Humans; Kidney Function Tests; Male; Mefenamic Acid; Methods; Muscle Cramp; Occult Blood; ortho-Aminobenzoates; Placebos; Potassium; Prothrombin; Sleep Initiation and Maintenance Disorders; Sodium; Uric Acid; Vertigo; Vision Disorders; Vomiting; Warfarin

Sepsis is a syndrome of life-threatening organ dysfunction caused by a dysregulated host response to infection. It can have devastating consequences, including bilateral adrenal hemorrhage, particularly in patients at high thrombotic risk, such as those with antiphospholipid syndrome and those on long-term anticoagulation.. A 49-year-old white woman re-presented to hospital with a history suggestive of sepsis. She had a medical background of primary antiphospholipid syndrome on lifelong warfarin. Ten days prior to this presentation, she had been hospitalized following Escherichia coli bacteremia, commenced on intravenous antibiotics, and discharged 2 days later with a prescribed 5-day course of oral amoxicillin. On readmission, she had ongoing fever, myalgia, malaise, and hypotension. Investigations revealed anemia with thrombocytopenia, hyponatremia, and acute-on-chronic kidney injury. Despite treatment for urosepsis, she became tachypneic, clammy, light-headed, drowsy, and hypothermic. Computed tomography revealed bilateral adrenal hemorrhage, and biochemical examination confirmed hypoadrenalism. Following discharge, she had persistent renal and hepatic injury lasting 3 months.. Early identification, intensive monitoring, and aggressive support may reduce the acquired thrombotic risk and avoid potentially life-threatening outcomes of sepsis.

Topics: Abdominal Pain; Adrenal Gland Diseases; Adrenal Glands; Adrenal Insufficiency; Anti-Bacterial Agents; Anti-Inflammatory Agents; Antiphospholipid Syndrome; Diarrhea; Escherichia coli; Female; Hemorrhage; Humans; Hydrocortisone; Middle Aged; Sepsis; Tomography, X-Ray Computed; Treatment Outcome; Vomiting; Warfarin

To describe a case of subtherapeutic international normalized ratio (INR) associated with concomitant use of warfarin and banana flakes in a patient with diarrhea.. A man in his 30s was hospitalized for an elective procedure, but his stay was complicated by cerebral venous thrombosis requiring intravenous infusion of unfractionated heparin, ventilator-associated pneumonia, bacteremia requiring broad-spectrum antimicrobials and percutaneous endoscopic gastrostomy tube placement, and diarrhea. Eventually, the heparin was transitioned to warfarin. After several days of therapeutic INR, the INR became subtherapeutic and remained so for 3 days. The decreased INR correlated temporally with initiation of consistent administration of dried banana flakes to treat diarrhea and the subsequent decrease in the rate and extent of diarrhea. Diarrhea decreases the amount and activity of vitamin K-producing intestinal flora and dietary vitamin K absorption, resulting in increased INR. Resolution of diarrhea secondary to banana flakes administration in this patient may have contributed to the decreased INR by causing a relative increase in vitamin K-producing flora and vitamin K absorption. A probability score of 5 was obtained upon applying the Drug Interaction Probability Scale modified to address interactions between warfarin and dietary supplements, indicating a probable interaction between warfarin and banana flakes.. Concomitant use of warfarin and banana flakes supplements may result in a reduced rate and extent of diarrhea and may be associated with subtherapeutic INR and decreased warfarin efficacy. Practitioners must be aware of this potential interaction and closely monitor INR and adjust warfarin doses accordingly.

Topics: Adult; Anticoagulants; Cerebrovascular Disorders; Diarrhea; Dietary Supplements; Drug Interactions; Humans; International Normalized Ratio; Male; Musa; Venous Thrombosis; Vitamin K; Warfarin

Capsule endoscopy is a promising method for examining the small intestine. The study was performed to evaluate the use of capsule endoscopy in clinical routine in patients with suspected disease of the small intestine.. Consecutive patients with clinically suspected disease of the small intestine referred for capsule endoscopy between 1 January 2003 and 31 December 2004 were included in the study. All patients had previously completed a conventional diagnostic work-up with upper and lower endoscopy as well as abdominal CT scan or small-bowel enteroclysis.. A total of 167 patients were referred during the time period and 195 procedures were performed. Seventeen (8.7%) of the procedures were unsuccessful, with no visualization of the small bowel. In the remaining procedures the caecum was reached in 83%. The reason for referral was gastrointestinal bleeding (30%), iron-deficiency anaemia (25%), abdominal pain (15%), diarrhoea (13%) and Crohn's disease (12%). Pathology was found in 27% of the patients, with the highest diagnostic yield in patients referred for Crohn's disease (60%) and the lowest yield (4%) in patients referred for abdominal pain. There were no complications, with the exception of one patient referred for Crohn's disease who had transient abdominal pain during the procedure.. Capsule endoscopy is a safe and well-tolerated procedure. In unselected patients with clinically suspected disease of the small intestine, the procedure gives additional information to conventional diagnostic procedures in 27% of patients. Incomplete examination of the small intestine was frequent in our group of patients.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Cyclooxygenase Inhibitors; Diarrhea; Endoscopy, Gastrointestinal; Female; Humans; Intestinal Diseases; Intestine, Small; Male; Middle Aged; Norway; Prospective Studies; Warfarin

Topics: Anticholesteremic Agents; Anticoagulants; Cholestyramine Resin; Diarrhea; Drug Overdose; Humans; Injections, Intravenous; Vitamin K; Warfarin

We present a case of significant over-anticoagulation temporally associated with a bout of protracted diarrhea in a patient on warfarin therapy. Cholestyramine was utilized to interrupt the enterohepatic recycling of warfarin and for its antidiarrheal effects to prevent gastrointestinal vitamin K wasting. Cholestyramine enabled the use of very low doses of sc vitamin K1 (2 mg total) with subsequent attainment of a therapeutic International Normalized Ratio in 39 h.

Topics: Aged; Anticholesteremic Agents; Anticoagulants; Blood Chemical Analysis; Cholestyramine Resin; Diarrhea; Electrocardiography; Enzyme Inhibitors; Female; Hematocrit; Hemoglobins; Humans; Leukocyte Count; Partial Thromboplastin Time; Platelet Count; Prothrombin Time; Rifampin; Vitamin K; Warfarin

To report a case of international normalized ratio (INR) prolongation in a patient receiving warfarin who experienced several episodes of diarrhea.. A 56-year-old white woman, previously controlled on warfarin therapy (INR 2.5-3.5) after aortic valve replacement, experienced six episodes of INR elevation, each associated with an acute bout of diarrhea lasting from one to four days. The patient had not received additional warfarin or new medications (including nonprescription medications and herbal remedies) prior to the episodes. The patient had no obvious signs of bleeding (except bruising on 1 episode) or signs of infection determined through physician evaluation of the patient and her stools. In addition, she had no diagnosis of liver disease or acute or chronic malabsorption. The patient did report that her dietary intake decreased to 25-50% of normal during these episodes of diarrhea, which may result in decreased vitamin K ingestion.. This is one of the first case reports documenting a trend of INR elevation specifically with episodes of diarrhea. Since most of the common reasons for acute INR elevation have been eliminated, diarrhea with decreased oral intake are the most probable causes for these observed changes in the INR. Several reports suggest that acute diarrhea results in malabsorption of vitamin K, which can predispose patients taking warfarin to INR elevations, but in many of these reports patients had other risk factors for INR elevation. Although the effect of diarrhea on vitamin K absorption and the INR is difficult to quantify, the INR elevation reported here seemed to be directly associated with the duration of each diarrheal episode.. Diarrhea episodes in patients receiving warfarin can result in prolongation of the INR and possible bleeding. Patients who experience diarrhea or decreased oral intake resulting in elevated INRs should have their INRs evaluated more frequently and their warfarin doses adjusted appropriately.

Topics: Acute Disease; Anticoagulants; Diarrhea; Female; Humans; International Normalized Ratio; Middle Aged; Vitamin K; Warfarin

Topics: Diarrhea; Giardiasis; Hemorrhage; Humans; Vitamin K; Warfarin

Topics: Adult; Aged; Ascorbic Acid; Diarrhea; Drug Interactions; Female; Humans; Male; Middle Aged; Prothrombin; Time Factors; Warfarin

Several toxic agents were compared in order to test the effect of various types of illness in producing learned taste aversions. After a 10-min sucrose drinking trial, groups of rats were injected intraperitoneally with lithium chloride or with a strong, near lethal dose of a rodenticide. Strong sucrose aversions were acquired by groups injected with lithium chloride, copper sulfate, sodium fluoroacetate, or red squill, and very weak or no aversions were learned by groups injected with thallium, warfarin cyanide, or strychnine. The results were discussed in terms of onset of symptoms, duration of symptoms, and kinds of physiological effects necessary to produce aversions. It was concluded that the effects of different drugs may be mediated by different physiological systems learned taste aversions.

Topics: Animals; Avoidance Learning; Copper; Cyanides; Diarrhea; Female; Fluoroacetates; Lithium; Male; Motor Activity; Plants, Medicinal; Rats; Rodenticides; Seizures; Sex Factors; Strychnine; Sulfates; Taste; Thallium; Time Factors; Warfarin