Chinese herbs with, or as a substitute for, warfarin?

[Guest guest]

(see below)

 

 

 

-Jason

 

 

 

 

On Behalf Of

 

 

 

 

 

Questions for expert CHM practitioners:

 

(1) After multiple coronary arterial stenting, mitral valve repair or

mitral valve debridement and replacement by an artificial valve, if

YOU were prescribed conventional blood-thinners [Warfarin, Plavix,

Nuseal aspirin, etc] would YOU refuse to take the WMs and rely

instead on CHM to prevent clotting, embolism and heart attack?

 

In the initial stages (after surgery) you would be a fool to

monkey around with CM and not take WM. WM is much safer in this type of

situation. However, after some months, many times blood thinners are not

required or at least careful monitoring is not necessary. At this point

things are little more flexible.

 

 

 

(2) On another, but similar issue, if your cardiologist advised you

to take statins (Crestor or Lipitor, etc) and a beta-blocker (Emcor

or Cardicor, etc) daily for prolonged period, would you do so? Or

would you rely instead on CHMs that are said to have

hypocholesterolaemic and HT rectification action?

 

I would not take WM in this case, unless I could not control

the symptoms with alternative means, which is usually not that difficult.

Obviously in some serious situations a beta-blocker may be appropriate and

again I would not monkey around with this if your life depended on it.

 

Others?

 

-Jason

 

 

 

 

[Guest guest]

Blood thinners are required for 1 year post stent to prevent blowing the

stent out. This was explained to me by a cardiologist last November (2009),

so I believe it is still current. I agree with Jason it is fool-hardy to try

alternative means in this situation. AFAIK blood thinners are not required

beyond 1 year, though many doctors won't take you off them once you're on. 1

year post-stent is a scenario where I would consider CHM.

 

As for CHM for other cardiac issues, we have some great methods of measuring

progress using cutting edge WM. I see no problem using CM for treatment, but

feel it irresponsible to eschew WM for diagnostic testing. Markers like

homocysteine, HS-CRP, LP(a), fibrinogen, lipid subfractions, oxidized LDL,

and Triglyceride/HDL ratio can tell us much. Most of this info can be gotten

from a Berkeley Heartlabs lipid panel http://www.bhlinc.com/index.php.

 

Tim Sharpe

 

 

Thursday, May 13, 2010 7:48 AM

 

(see below)

 

 

 

 

On Behalf Of

 

Questions for expert CHM practitioners:

 

(1) After multiple coronary arterial stenting, mitral valve repair or

mitral valve debridement and replacement by an artificial valve, if

YOU were prescribed conventional blood-thinners [Warfarin, Plavix,

Nuseal aspirin, etc] would YOU refuse to take the WMs and rely

instead on CHM to prevent clotting, embolism and heart attack?

 

In the initial stages (after surgery) you would be a fool to

monkey around with CM and not take WM. WM is much safer in this type of

situation. However, after some months, many times blood thinners are not

required or at least careful monitoring is not necessary. At this point

things are little more flexible.

[Guest guest]

Regarding adding blood activating herbs to blood thinning drugs:

 

One reason that warfarin keeps coming up in herb/drug interaction

discussions is because warfarin has a narrow safe therapeutic zone. Too much

and a patient can bleed internally, not enough and the patient can have a

stroke.

 

I just recently ran into an herb/drug interaction in a patient who was on

another cardiovascular drug; Coreg CR (carvedilol phosphate).

 

From the Coreg CR website:

 

COREG CR is a once-a-day medicine called a beta-blocker. A beta-blocker is a

type of medicine that lowers blood pressure by helping the heart beat more

slowly and with less force. This puts less strain on the heart. COREG CR

also causes the blood vessels to relax. This means there is less resistance,

which helps blood to flow throughout the body.*

 

* The way in which beta-blockade lowers blood pressure is unknown.

 

COREG CR can help people who:

 

- Have *high blood pressure* (also called hypertension)

- Have had a *heart attack* that reduced how well the heart pumps

- Have *heart failure*

 

This patient has numerous open sores on his face. The patient said that he'd

had them for the past 30 years (he's 65) and nobody was ever able to do

anything about them. They looked like a dang gui indication to me (chronic

non-healing sores).

 

I gave this patient Si Wu Tang plus si gua lou and chi shao. There were a

few other items in the formula too for non blood-related issues.

 

The patient soon reported fatigue, dizziness, and hypersomnolence. He went

to his doctor who then lowered the dosage of this drug. The symptoms went

away.

 

Looking at the Coreg CR website, I note the following warning:

 

*People should not take COREG CR if they take certain intravenous drugs that

help support their circulation (inotropic medications).*

 

This warning does not include the symptoms that may arise if they do, but it

is clear that the CM treatment principle of activating blood had an additive

affect to this drug.

 

The outcome of lowering the drug dosage was a positive change in my opinion.

The patient is also on board with lowering dosages of his (numerous) drugs

and is showing improvement in his skin condition. So I'm happy with the

interaction, but this is the first time that a treatment principle such as

" activating blood " has had such a clear and obvious additive therapeutic

quality ala what many talk about in regards to warfarin interactions.

 

-al.

--

, DAOM

Pain is inevitable, suffering is optional.

http://twitter.com/algancao

 

 

 

[Guest guest]

Why would herbs that thin the blood to a certain range be any safer (or

preferred) to a drug such as Warfarin. Meaning why do we think that the

increase of bleeding is less likely with herbs? The point of these drugs is

to decrease blood coagulation and get the INR to a certain therapeutic range

(e.g. 2-3). However, if we are to use herbs to get to the same level, isn't

the chance the same? Is there some evidence that suggests that giving an

herbal formula to perform the exact same function any safer?

 

 

 

Comments?

 

 

 

-Jason

 

 

 

 

On Behalf Of Al Stone

Thursday, May 13, 2010 8:35 AM

 

Re: Chinese herbs with, or as a substitute for, warfarin?

 

 

 

 

 

Regarding adding blood activating herbs to blood thinning drugs:

 

One reason that warfarin keeps coming up in herb/drug interaction

discussions is because warfarin has a narrow safe therapeutic zone. Too much

and a patient can bleed internally, not enough and the patient can have a

stroke.

 

I just recently ran into an herb/drug interaction in a patient who was on

another cardiovascular drug; Coreg CR (carvedilol phosphate).

 

From the Coreg CR website:

 

COREG CR is a once-a-day medicine called a beta-blocker. A beta-blocker is a

type of medicine that lowers blood pressure by helping the heart beat more

slowly and with less force. This puts less strain on the heart. COREG CR

also causes the blood vessels to relax. This means there is less resistance,

which helps blood to flow throughout the body.*

 

* The way in which beta-blockade lowers blood pressure is unknown.

 

COREG CR can help people who:

 

- Have *high blood pressure* (also called hypertension)

- Have had a *heart attack* that reduced how well the heart pumps

- Have *heart failure*

 

This patient has numerous open sores on his face. The patient said that he'd

had them for the past 30 years (he's 65) and nobody was ever able to do

anything about them. They looked like a dang gui indication to me (chronic

non-healing sores).

 

I gave this patient Si Wu Tang plus si gua lou and chi shao. There were a

few other items in the formula too for non blood-related issues.

 

The patient soon reported fatigue, dizziness, and hypersomnolence. He went

to his doctor who then lowered the dosage of this drug. The symptoms went

away.

 

Looking at the Coreg CR website, I note the following warning:

 

*People should not take COREG CR if they take certain intravenous drugs that

help support their circulation (inotropic medications).*

 

This warning does not include the symptoms that may arise if they do, but it

is clear that the CM treatment principle of activating blood had an additive

affect to this drug.

 

The outcome of lowering the drug dosage was a positive change in my opinion.

The patient is also on board with lowering dosages of his (numerous) drugs

and is showing improvement in his skin condition. So I'm happy with the

interaction, but this is the first time that a treatment principle such as

" activating blood " has had such a clear and obvious additive therapeutic

quality ala what many talk about in regards to warfarin interactions.

 

-al.

--

, DAOM

Pain is inevitable, suffering is optional.

http://twitter.com/algancao

 

 

[Guest guest]

Jason,

 

I don't have a problem with drugs to save lives. However, when we can

replace them with herbs, I think that's a great idea, isn't that kind of

what we do? I'm not convinced that a replacement is necessarily the best

choice when it comes to warfarin, so I don't want to try and defend the

replacement of this drug with herbs.

 

My case didn't deal with a life threatening issue such as blood coagulation.

However, since much of our herb/drug interaction data is theory alone, when

an observable interaction does take place, I take note, especially because

of the Coreg CR's caution against intravenous drugs that support circulation

having the same therapeutic principles as a formula such as Si Wu Tang or

blood activators.

 

-al.

 

On Thu, May 13, 2010 at 8:08 AM, <

> wrote:

 

>

>

> Why would herbs that thin the blood to a certain range be any safer (or

> preferred) to a drug such as Warfarin. Meaning why do we think that the

> increase of bleeding is less likely with herbs? The point of these drugs is

> to decrease blood coagulation and get the INR to a certain therapeutic

> range

> (e.g. 2-3). However, if we are to use herbs to get to the same level, isn't

> the chance the same? Is there some evidence that suggests that giving an

> herbal formula to perform the exact same function any safer?

>

> Comments?

>

> -Jason

>

> <%40>

>

[ <%40>\

]

> On Behalf Of Al Stone

> Thursday, May 13, 2010 8:35 AM

> <%40>

> Re: Chinese herbs with, or as a substitute for, warfarin?

>

>

> Regarding adding blood activating herbs to blood thinning drugs:

>

> One reason that warfarin keeps coming up in herb/drug interaction

> discussions is because warfarin has a narrow safe therapeutic zone. Too

> much

> and a patient can bleed internally, not enough and the patient can have a

> stroke.

>

> I just recently ran into an herb/drug interaction in a patient who was on

> another cardiovascular drug; Coreg CR (carvedilol phosphate).

>

> From the Coreg CR website:

>

> COREG CR is a once-a-day medicine called a beta-blocker. A beta-blocker is

> a

> type of medicine that lowers blood pressure by helping the heart beat more

> slowly and with less force. This puts less strain on the heart. COREG CR

> also causes the blood vessels to relax. This means there is less

> resistance,

> which helps blood to flow throughout the body.*

>

> * The way in which beta-blockade lowers blood pressure is unknown.

>

> COREG CR can help people who:

>

> - Have *high blood pressure* (also called hypertension)

> - Have had a *heart attack* that reduced how well the heart pumps

> - Have *heart failure*

>

> This patient has numerous open sores on his face. The patient said that

> he'd

> had them for the past 30 years (he's 65) and nobody was ever able to do

> anything about them. They looked like a dang gui indication to me (chronic

> non-healing sores).

>

> I gave this patient Si Wu Tang plus si gua lou and chi shao. There were a

> few other items in the formula too for non blood-related issues.

>

> The patient soon reported fatigue, dizziness, and hypersomnolence. He went

> to his doctor who then lowered the dosage of this drug. The symptoms went

> away.

>

> Looking at the Coreg CR website, I note the following warning:

>

> *People should not take COREG CR if they take certain intravenous drugs

> that

> help support their circulation (inotropic medications).*

>

> This warning does not include the symptoms that may arise if they do, but

> it

> is clear that the CM treatment principle of activating blood had an

> additive

> affect to this drug.

>

> The outcome of lowering the drug dosage was a positive change in my

> opinion.

> The patient is also on board with lowering dosages of his (numerous) drugs

> and is showing improvement in his skin condition. So I'm happy with the

> interaction, but this is the first time that a treatment principle such as

> " activating blood " has had such a clear and obvious additive therapeutic

> quality ala what many talk about in regards to warfarin interactions.

>

> -al.

> --

> , DAOM

> Pain is inevitable, suffering is optional.

> http://twitter.com/algancao

>

>

[Guest guest]

(see below)

 

-Jason

 

 

 

 

On Behalf Of Al Stone

 

 

However, when we can replace them with herbs, I think that's a great idea,

isn't that kind of

what we do? I'm not convinced that a replacement is necessarily the best

choice when it comes to warfarin, so I don't want to try and defend the

replacement of this drug with herbs.

 

Well that all depends. I don't want to think that is just

what I do. I think I try to do what is best for the patient overall. Too

often, we just think herbs are better, end of story. But in this case, as

you say, that might not be so.

 

-Jason

[Guest guest]

Hi All,

 

Though I cannot remember who, or on what specific List, someone asked

if colleagues could recommend specific CMs that are as potent and

reliable as warfarin as blood-thinners, but safer than warfarin as

regards risk of bleeding or other side effects.

 

In " WARFARIN + CHINESE MEDICINE " www;itmonline;org/arts/warfarin;htm

Subhuti Dharmananda lists many herbs that act on blood and clotting.

 

However, paraphrasing him, he says:

> " Although CHMs, esp Danshen, Chuanxiong, Honghua, + Gegen, are used

> extensively in China to Tx people who otherwise might receive

> warfarin, there is little evidence that these / other CHMs have

> anticoagulant action comparable to that of warfarin / even aspirin;

 

> TCM literature provides some cautions for use of Hbs in bleeding, such

> as during menses, because of concern of increasing total Xue loss,

> indicating that clotting time may be prolonged somewhat;

 

> There is some evidence to suggest that CHMs can interact w warfarin,

> but number of reports is quite low + evidence of effects is limited;

> Danshen is suggested to have such an interaction, but only 3 cases

> have been reported (9), despite its widespread use by persons who have

> Xue coagulation problems; they involved large changes in INR, however;

>

 

> One clinical report of interaction w warfarin involved Danggui (10); a

> laboratory study showed limited interaction (11); Dasuan, Renshen +

> Baiguoye are Hbs mentioned briefly in literature as potentially

> interacting w warfarin;

 

> In a recent evaluation of reports about Hb-drug interactions, few

> publications contained enough data to evaluate actual interaction;

> only 18 / 108 involved warfarin, + most of those involved St; John's

> Wort (11);

 

> In a survey of people in Hong Kong starting warfarin Tx, it was found

> that about 1 / 4 were taking CHMs (12); Their INR values, rather than

> being enhanced, were slightly lower, + this corresponded w a somewhat

> lower dose of warfarin taken by those who were using Hbs;

 

> Thus, it may be possible to use these Hbs along w warfarin Tx, so long

> as monitoring of INR is maintained in order to detect rare

> interactions; When Hbs provide additional benefits to cardiovascular

> system (aside from simple anti-coagulation), effect of total treatment

> may be improved compared to drug Tx alone; It is important to consider

> that when PT test is carried out, it measures coagulation of Xue that

> is removed from body; test does not indicate any conditions of

> vascular system that may lead to induction of clotting; yet, such

> conditions may be very important in determining whether / not a

> serious clotting event will occur; Those other conditions may be

> addressed by Hbs; "

 

Questions for expert CHM practitioners:

 

(1) After multiple coronary arterial stenting, mitral valve repair or

mitral valve debridement and replacement by an artificial valve, if

YOU were prescribed conventional blood-thinners [Warfarin, Plavix,

Nuseal aspirin, etc] would YOU refuse to take the WMs and rely

instead on CHM to prevent clotting, embolism and heart attack?

 

(2) On another, but similar issue, if your cardiologist advised you

to take statins (Crestor or Lipitor, etc) and a beta-blocker (Emcor

or Cardicor, etc) daily for prolonged period, would you do so? Or

would you rely instead on CHMs that are said to have

hypocholesterolaemic and HT rectification action?

 

If we talk the talk, should we walk the walk?

 

Best regards,

 

[Guest guest]

Hi Phil -

 

1) I would take what is prescribed on an acute basis following some form of

invasive cardiac procedure. However, I would request a weekly assessment of

blood viscosity. I would further compliment the Warfarin with appropriate blood

thinners. I have never seen a patient on Warfarin without frank signs of blood

stasis. It clearly does not do an adequate job. I would then move towards

eliminating the pharmaceutical approach, especially Warfarin given the increased

risk of CVA. I have managed patients on precisely these terms with co-operative

cardiologists. Such willing partners in team based care are few and far between.

 

2) As for Statins, I am unlikely. There are so many lifestyle factors involved

in lipid profiles and the cholesterol myth is rather complicated. As for

hypertension - maybe but only for a short term. Heck, I would do statins on the

short term. The reasons for hyperlipidenia and hypertension have to be resolved.

If not, the medications will operate in liu of the ability to manage the life in

a way the mitigates the condition. Same for diabetes.

 

Warmly,

 

Will

 

Questions for expert CHM practitioners:

 

(1) After multiple coronary arterial stenting, mitral valve repair or

mitral valve debridement and replacement by an artificial valve, if

YOU were prescribed conventional blood-thinners [Warfarin, Plavix,

Nuseal aspirin, etc] would YOU refuse to take the WMs and rely

instead on CHM to prevent clotting, embolism and heart attack?

 

(2) On another, but similar issue, if your cardiologist advised you

to take statins (Crestor or Lipitor, etc) and a beta-blocker (Emcor

or Cardicor, etc) daily for prolonged period, would you do so? Or

would you rely instead on CHMs that are said to have

hypocholesterolaemic and HT rectification action?

 

If we talk the talk, should we walk the walk?

 

Best regards,

 

[Guest guest]

Thank you for raising this topic.

 

The necessity of blood thinning agents is absolutely necessary after surgeries.

I always think how long people have to take Coumadin, Plavix...

I see the black macular eruptions on the skin of the patients who take blood

thinners for a long time. I did not see black blotches on the skin when I was

in China.

For a few years now I struggle with myself when I see patients on Coumadin and

yet they have blood stasis. Do I have give them herbs or not, especially when

I see that the color of blood is still black...(Sometimes I prick the skin on

purpose to see the blood color). If patient wants to ADD something to the WM,

than I give them some herbs. Many of these patients are under monitor for blood

thinning/clotting, so I feel better when I carefully add herbs.

 

What bothers me more is that MD do not do pattern differentiation when they give

the blood thinning medicine. Blood clots due to atherosclerosis, or lipids, or

erythrocytes sticking, etc.

Few of my patients with atherosclerosis on Warfarin within two years go to the

ER for another surgeries (stents).

 

This is probably because the use of warfarin, a commonly used anticoagulation

drug, is associated with increased amounts of coronary artery calcification.

Studies in animals and preliminary but small retrospective studies in humans

have suggested a possible link to increased tissue calcification with use of

this drug.

 

Because we cannot tell people not to take the WM, we still have to do something

to protect our patients.

I developed some sort of combination of TCM/Homeopathy/vitamins for patients in

these condition. I do use Dan Shen... I do recommend nattokinase (vitamin K2),

Magnesium...

I am absolutely aware of the potential drug interaction. But are the WM doctors

aware of that giving the blood thinning drugs to patients with atherosclerosis

they do more harm than good...

 

Beta-blockers... MDs often prescribe it to patients who had a heart attack,

mostly trying to take care a blood pressure. I remember, I was asking one very

good surgion in Cornell Med.Center in NY about why he prescribed Beta-blockers,

statin drugs to people who had heart attack but did not have any BP, or

cholesterol issue.. He honestly answered: " We do not know how to treat those

patients " ...

 

My lit.research showed that in case of heart attack (with stents to treat

it)Beta-blockers are used mostly not to take care of blood pressure, but to

avoid adhesions. If you confident with your supplements you can use something

else instead of beta-blockers.

 

Anyway it is a difficult topic, takes some courage to confront some of the

meds...

 

I would like to see what other practitioners use with patients on Coumadin and

other drugs.

 

 

Tatiana

 

- In Chinese Medicine , " "

< wrote:

>

> Hi All,

>

> Though I cannot remember who, or on what specific List, someone asked

> if colleagues could recommend specific CMs that are as potent and

> reliable as warfarin as blood-thinners, but safer than warfarin as

>