Monday, 2 December 2013


What is Coumadin?

Warfarin, sold in the drugstores under the brand name Coumadin, is a prescription drug that prevents the formation of blood clots, which belong to a class otherwise known as blood thinners.

How are blood clots formed?

A process known as hemostasis prevents or stops blood loss from an injured blood vessel. There are four steps involved in this process.

  • Constriction of blood vessels : special cells known as endothelial cells stick to one another (like a stack of coins) at the site of injury initially stopping bleeding
  • Platelet plug formation: special cells known as platelets replace the endothelial cells to form another plug to stop the bleeding which occurs just seconds after the injury.
  • Fibrin formation: fibrin clot is created
  • Fibrinolysis: breakdown of the fibrin clot and replaced by a connective tissue as the injured vessel wall is healed. Some of these blood clots may travel into the blood stream, form a blockage which subsequently reduces blood flow resulting in conditions like cerebral embolism (block in vessels leading to a part of the brain).

The liver produces substances, known as clotting factors, which are part of the clot formation. To be able to produce these clotting factors, vitamin K is needed.

What about vitamin K?

Vitamin K is one of the fat-soluble vitamins, absorbed in the small intestine and stored in the liver, which is important in controlling bleeding. It is a component in the coagulation process.

How does Coumadin prevent formation of blood clots?

Coumadin blocks the transformation of the inactive form of vitamin K to its active form causing disruption in the steps for clot formation resulting in longer time for the blood to clot.

What are the beneficial effects of Coumadin in the body?

It slows down clot formation and prevents the recurrence of blockage in the distant veins and in the lungs. If there is an existing clot, it stops it from growing larger. In people with artificial heart valves and those who had a heart attack, it likewise prevents the formation of blood clots.

What are the harmful effects of Coumadin in the body?

In pregnancy, it causes spontaneous abortion, stillbirth, neonatal death, preterm birth, birth defects like abnormal bone formation, and seizures.

Since it stops the coagulation process, it can cause excessive bleeding or hemorrhage in the event of injuries or surgery.

Within the bones it causes osteoporosis or “brittle bone. On the skin, it creates dark red or black lesions.

What to watch out for?

1. nosebleeding

2. dark stools

3. dark urine

4. coughing up or vomiting of blood

5. joint pains

6. bruising without any injury

7. presence of rashes on the skin

What are the drugs that interact with Coumadin?

Drugs that increase anticoagulant effect and risk of bleeding

1. Aspirin

2. Metronidazole

3. Cephalosporins

4. Cimetidine

5. Miconazole

6. Trimethoprim-sulfamethoxazole

7. Heparin

8. Amiodarone

9. Ibuprofen (example. Advil)

Drugs that decrease anticoagulant effect and risk of bleeding

1. Vitamin K

2. Rifampin

3. Barbiturates (example. Phenobarbital)

4. Cholestyramine

Other factors that interact with Coumadin

1. Liver disease

2. Hyperthyroidism

3. Hereditary resistance

4. Intake of foods like cranberry juice, spinach, broccoli, mangosteen

What about Mangosteen?

Mangosteen, a fruit native to Southeast Asian countries like Thailand, Indonesia, and Philippines, is known for its high medicinal value and antioxidant content.

What are antioxidants?

Antioxidants are molecules which can safely interact with free radicals and thus prevent body cell damage. It is known to help maintain the immune system which makes our body fight diseases like common colds caused by viruses. It also acts as an anti-inflammatory agent which helps alleviate symptoms of arthritis.

Antioxidants present in Mangosteen are:

§ Xanthones: known not only for is antioxidant property but also for its immune system booster and anti-inflammatory properties. Helps heal cells damaged by free radicals,

§ Catechins

§ Polyphenols: fights oxidative stress that causing both neurodegenerative and cardiovascular diseases.

§ Proanthocyanidins: Strong anti-oxidant

§ Sterols: helps in the reduction in the amount of blood plasma cholesterol in the body

Choosing Mangosteen Supplements

Between the juice and pill form, the latter has far more advantage in bringing you the maximum health benefits. It contains 100% mangosteen, while the juice form uses other fruit extracts to improve its taste, and preservatives to prolong its shelf life. It leaves little percentage of mangosteen in the bottle supposedly marketed as mangosteen juice.

The manufacturing process of the juice form involves processes such as pasteurization and reconstitution which destroy the natural medicinal properties of mangosteen.

The whole fruit is utilized in the manufacturing of the juice. For the whole fruit to be transported to the United States for processing, it is required by the law to undergo irradiation to kill pests, bacteria and viruses. The radiation effects to your food may be passed on to your body, putting you at risk for cancer.

The pill form does not have to go through the same harmful procedures. It uses only the pericarp or rind of the mangosteen , where the xanthones are highly concentrated. After being freeze-dried, it is transported for processing without the need for irradiation.

Mangosteen and Coumadin

Mangosteen does not have vitamin K that may exert an opposite effect against blood thinners. In laboratory studies, mangosteen was found to increase the risk of bleeding.

Anti-inflammatory drugs like Coumadin block blood clot formation by preventing the platelets to stick to one another. It stops the production of Thromboxane A2, a substance that makes the platelets change shape and stick to one another. Bleeding is therefore prolonged.

This is believed to be the mechanism of action of mangosteen that reduces clotting. It means that if a person is on “blood thinners” like Coumadin, should be educated and informed that mangosteen may double the effect of Coumadin.

In the case of injury or the need for surgery, it may be difficult to stop bleeding if both mangosteen and coumadin are taken, which may lead to blood loss. However, there has been no documented case to date, of mangosteen causing problems on patients taking Coumadin despite what laboratory findings on animals suggest.

If you are on any supplements, it would be wise to inform your physician what you are regularly taking, so that he or she will be informed of the possible interactions of the drugs to be prescribed and the supplements that you are religiously taking. This will prevent any complications in the future.


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