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Pickles and warfarin interaction: a case-based review.

Alexa Rangecroft1, Shamit S Prabhu2, Chi-Cheng Huang3

  • 1Wake Forest School of Medicine, Winston-Salem, NC, USA. arangecr@wakehealth.edu.

Clinical Rheumatology
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PubMed
Summary
This summary is machine-generated.

Patients on warfarin should maintain consistent vitamin K intake, as dietary changes like stopping pickles can dangerously increase INR. Educating patients on vitamin K-rich foods is crucial for preventing bleeding risks.

Keywords:
AntiphospholipidPicklesVitamin KWarfarin

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Area of Science:

  • Internal Medicine
  • Pharmacology
  • Nutrition

Background:

  • Warfarin (a common anticoagulant) requires careful management of dietary vitamin K intake.
  • Historically, restricting vitamin K was advised, but current evidence emphasizes consistency over strict limitation.
  • Patients on warfarin often lack awareness regarding vitamin K content in various foods.

Observation:

  • A 36-year-old woman with lupus and antiphospholipid syndrome on warfarin presented with a significantly elevated INR (9).
  • Her elevated INR occurred despite a stable warfarin dosage and was linked to her recent cessation of dill pickle consumption.
  • Dill pickles, often overlooked, are a source of vitamin K.

Findings:

  • Sudden dietary changes, such as eliminating vitamin K-rich foods like pickles, can lead to supratherapeutic anticoagulation.
  • Consistent dietary vitamin K intake is paramount for stable warfarin efficacy.
  • Patient education on identifying and consistently consuming vitamin K-containing foods is essential.

Implications:

  • Healthcare providers must educate patients on the importance of consistent vitamin K intake and list common food sources, including pickles.
  • This case highlights a potential, underrecognized factor contributing to warfarin-related bleeding complications.
  • Improved patient counseling can enhance warfarin safety and reduce the incidence of bleeding events.