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Multivitamin for Patients on Blood Thinners Vitamin K and Anticoagulants (warfarin, Coumadin®, Jantoven®, Marfarin®) Vitamin K is a fat-soluble vitamin and plays a key role in the clotting cascade. The clotting cascade is a series of chemical reactions that occur in the body and result in coagulation to stop bleeding after an injury. Warfarin lengthens the amount time it takes for the clotting cascade to form a clot by decreasing the activity of vitamin K.

Found primarily in green leafy vegetables, vitamin K inhibits the effects of warfarin. While warfarin works to increase International Normalization Ratio (INR), or lengthen the amount of time it takes to form a clot, vitamin K works against it to decrease INR, or shorten the amount of time it takes to form a clot. It is therefore vital that all patients on warfarin eat a consistent amount of vitamin K daily. This way, the amount of warfarin needed to achieve the INR goals can be adjusted to account for the amount of vitamin K ingested. Sporadic consumption of vitamin K will result in either an increase or decrease of INR and the associated risks, which range from clot formation if INR is too low to excessive bleeding if INR is too high. Both of these adverse events can be fatal.

Due to the risks associated with irregular vitamin K intake, it is essential that patients taking warfarin consume a consistent amount of vitamin K daily so their warfarin dose can be adjusted to that level of vitamin K intake.

This is the best possible way to avoid constant adjustments of the warfarin dose, decrease the number of times INR must be tested each month, and, most importantly, decrease the likelihood of a potentially fatal adverse event.

In addition to eating a consistent amount of vitamin K daily, it is important for patients taking warfarin to only consume up to the recommended daily intake (RDI) of vitamin K. The current RDI is 90 micrograms for women and 120 micrograms for men. ==References==

It is recommended not to exceed that amount daily; however, always consult your physician before making changes to your diet.

Most complete multivitamins will contain approximately 15 to 25 micrograms of vitamin K. This means that a patient taking warfarin and a multivitamin could be getting over 25% of their RDI of vitamin K solely from the multivitamin. To make matters worse, many multivitamins and supplements contain other ingredients besides vitamin K that can interfere with warfarin including soy, niacin, and large amounts of vitamin E, vitamin C and magnesium. ==References==

K Free Daily is the safest complete multivitamin available for patients on warfarin. It is formulated without vitamin K, soy or niacin, and with clinically-proven safe levels of vitamin E, vitamin C and magnesium. K Free Daily also includes all the essential vitamins and minerals found in the leading multivitamin brands.

Foods High In Vitamin K Foods High in Vitamin K In general, dark, green leafy vegetables are the foods highest in vitamin K. The current RDI of vitamin K is 90 micrograms for women and 120 micrograms for men. It is important that patients taking warfarin do not exceed the recommended daily intake. Below is a selection of common vitamin K containing foods and their vitamin K content. ==References==

Food	Measure	Content Per Measure (micrograms) Cooked Kale	1 cup	1062.1 Cooked Spinach	1 cup	888.5 Cooked collards	1 cup	836 Beet greens	1 cup	697 Turnip Greens	1 cup	529.3 Mustard Greens	1 cup	419.3 Brussels Sprouts (cooked)	1 cup	218.9 Broccoli (cooked)	1 cup	220.1 Onions (Raw)	1 cup	207 Butterhead Lettuce	1 head	116.7 Spinach (raw)	1 cup	144.9 Sauerkraut (canned)	1 cup	135 Iceberg Lettuce	1 head	129.9 Broccoli (raw)	1 cup	89.4 Cabbage (cooked)	1 cup	73.4 Romaine Lettuce (raw)	1 cup	57.4 Celery (cooked)	1 cup	56.7 Broccoli (cooked)	1 spear	52.2 Cucumber (raw, w/ peal)	1 large	49.4 Spinach (raw)	1 leaf	48.3 Asparagus (cooked)	4 spears	48 Blueberries	1 cup	40.7 Peas (cooked)	1 cup	40 Pumpkin (canned)	1 cup	39.2 Fish, canned tuna	3 oz	37.4 Carrot juice	1 cup	36.6 Kiwi Fruit (raw)	1 medium	30.6 Tomatoes (canned paste)	1 cup	29.9 Blackberries	1 cup	28.5 Artichoke (cooked)	1 cup	24.9 Parsley (dried, spice)	1 tbsp	17.7 Canola Vegetable Oil	1 tbsp	17.1 Margarine-butter blend	1 tbsp	14.7 Carrots (raw)	1 cup	14.5 Tomatoes (raw)	1 cup	14.2 Below are some of the most common nutrients (food and supplements) that may interact with warfarin

Alfala Avocado Beer Bilberry Cat’s Claw Celery Coenzyme Q10 Cranberry Ferverfew Fish Oil Garlic Ginger Ginkgo Ginseng Grapefruit Green Tea Horse Chestnut Licorice Niacin Onion Papin Pomegranate Red Clover Soy St. John’s Wart Turmeric Wheat Grass Willow Bark