Herbs contraindicated with Coumadin

[Guest guest]

Does anyone have a list of herbs contraindicated for use with

Coumadin (warfarin)? I know San Qi is one of them. Thanks.

[Guest guest]

" Does anyone have a list of herbs contraindicated for use with

Coumadin (warfarin)? I know San Qi is one of them. Thanks. "

 

Excellent and timely question. The FDA right now is in the process of

organizing a meeting about this very subject in terms of " nutritional

and herbal supplements. " However, I believe this whole thing is a

tempest in a teapot based on economic competition and biomedical

hegemony. Other than perhaps Dan Shen (Radix Salviae Miltiorrhizae),I

do not believe that there is any truly compelling research that any

Chinese herbs potentize the effects of warfarin (Coumadin). As far as

I know, there is only anecdotal and theoretical concern. If you look

at Blue Poppy's Herb Toxicities & Drug Interactions, under Dang Gui,

we only say " May exaggerate the anticoagulative effect of warfarin

(Coumadin). " " May, " not does.

 

Basically, this comes down to a fundamental mixing of apples and

oranges. There is nothing to suggest that Chinese blood-quickening

medicinals are blood-thinning. Blood-quickening is completely a

Chinese medical concept with its own definitions and parameters.

Blood-thinning is likewise a Western medical concept with its own

definitions and parameters. These are in no way interchangeable or the

same thing. Part of the problem here is the widespread misconception

that blood-quickeners cause or promote bleeding. That is factually

erroneous. Blood stasis is one of the four fundamental causes of

bleeding. Therefore, quickening the blood is a treatment principle

that is commonly used TO STOP BLEEDING.

 

Again, this goes back to terminology. The word huo, to quicken, means

two things: 1) to make something move faster and 2) to bring something

dead back to life. Nigel Wiseman chose this English term precisely

because it has these two English meanings. As I have stated before on

this forum, the Chinese word huo means both of these things. Static

blood is " dead blood. " But it is not necessarily thick blood.

Literally, it is also " dry blood " and " malign blood. " So quickening

means to bring dead blood back to life, i.e., to make it living,

engendering, nourishing, healthy.

 

There are a number of competitors in the health care marketplace who

want to put the kibbosh on alternative medicine. These people have the

ear of governmental regulators. There are also a lot of nervous

Nellies out there, within and without our profession. Our competitors

are using this issue to press for more control over our products and

practices, and I think it is extremely important that we not buy into

all of this.

 

If the schools did a better job of teaching all of us this medicine,

we would be in a better position to refute some of these attacks and

baseless concerns. As it is, we are extremely vulnerable to

misinformation and hearsay.

 

In any case, this is my current crusade and you can expect me to be

banging this drum for a while. Thanks for providing me the soapbox to

begin my campaign.

 

Bob

[Guest guest]

On Jan 14, 2005, at 8:48 AM, Bob Flaws wrote:

 

> " Does anyone have a list of herbs contraindicated for use with

> Coumadin (warfarin)? I know San Qi is one of them. Thanks. "

>

> Other than perhaps Dan Shen (Radix Salviae Miltiorrhizae),I

> do not believe that there is any truly compelling research that any

> Chinese herbs potentize the effects of warfarin (Coumadin).

 

Because of the narrow window of efficacy for warfarin and the

potentially deadly results of strokes or internal bleeding it would be

prudent to at least discuss tests that we can perform to determine if

the warfarin is being potentiated or neutralized by Blood moving herbs.

 

Isn't there some sort of skin scratch/clotting time test we can

perform? I just did a quick google search for such a thing, but all I

found were blood test parameters.

 

--

 

Pain is inevitable, suffering is optional.

-Adlai Stevenson

[Guest guest]

" Because of the narrow window of efficacy for warfarin and the

potentially deadly results of strokes or internal bleeding it would be

prudent to at least discuss tests that we can perform to determine if

the warfarin is being potentiated or neutralized by Blood moving herbs.

 

Isn't there some sort of skin scratch/clotting time test we can

perform? I just did a quick google search for such a thing, but all I

found were blood test parameters. "

 

Al,

 

This is a great suggestion. Please let me know if you find out

anything more about this. I also will nose about some this afternoon.

We need facts, not theory. Otherwise, we're going to see a whole class

of Chinese medicines restricted.

 

Bob

[Guest guest]

The following partial article on acquired platelet function disorder

does describe a simple, skin scratch clotting time test. However, it

does not give any reference ranges.

 

I'll keep looking.

 

Bob

 

Acquired platelet function disorder

By Thomas Fisher, MD

 

An acquired platelet function disorder refers to an abnormality in the

clotting ability of the platelets that develops sometime after birth.

Platelets are a type of cell found in the blood that help the blood to

clot. A number of disorders can affect the function of platelets.

 

What is going on in the body?

 

Platelets, along with a number of other substances in the blood, help

blood to clot. When a person cuts him- or herself, blood must clot, or

turn solid, to stop the bleeding. When platelets lose their ability to

function for any reason, abnormal bleeding and bruising may occur.

 

What are the signs and symptoms of the condition?

 

An acquired platelet function disorder may cause no symptoms at all.

When symptoms do occur, they are usually mild, unless the person has

another blood-clotting problem. Some of the symptoms include: ·

abnormally heavy bleeding from cuts or other injuries · easy bruising

· nosebleeds · petechiae, which are small red dots on the skin that

signal tiny areas of bleeding

 

What are the causes and risks of the condition?

 

There are many possible causes of acquired platelet function defect.

Common causes are as follows: · certain cancers of the blood, such as

multiple myeloma and polycythemia vera · long-standing kidney failure,

known as chronic renal failure · medicines, including aspirin,

penicillin, and nonsteroidal anti-inflammatory drugs, which are called

NSAIDs · open heart surgery · severe liver disease, such as cirrhosis

· systemic lupus erythematosus, which is an autoimmune disorder where

a person's immune system attacks his or her own body for unknown reasons

 

What can be done to prevent the condition?

 

Most cases of acquired platelet function defect cannot be prevented.

Avoiding alcohol abuse, which is the most common cause of cirrhosis,

could prevent many cases due to liver disease.

 

How is the condition diagnosed?

 

Diagnosis of acquired platelet function defect begins with a medical

history and physical exam. A blood test called a complete blood count,

or CBC, is often done first. This test counts the number and types of

cells in the blood.

 

If the platelet count is in a healthy range, a test called the

bleeding time can help confirm the diagnosis. In this test, the

forearm is scratched to cause a small area of bleeding. The amount of

time it takes for the scratch to stop bleeding is then measured. When

the platelets are not working properly, this time will be longer than

normal.

[Guest guest]

More on clotting time tests.

 

Bob

 

Types and differences of coagulation tests

Coagulation tests fall into three categories: general tests,

factor-specific tests and tests that measure the destruction (lysis)

of blood clots.

 

General coagulation tests provide a basic indication of the blood's

ability to clot. These tests cannot determine the exact nature of a

clotting problem, but some can indicate whether a clotting problem is

due to an intrinsic (inside the body) or extrinsic (outside the body)

factor. These tests are used for a variety of purposes, including

screening for a coagulation problem and monitoring the treatment of

patients on anticoagulants. The most common general coagulation tests

are the following:

 

* INR / prothrombin time. The International Normalization Ratio

(INR) is a ratio that helps physicians monitor patients taking

anticoagulant medications, such as warfarin. The ratio is used to

standardize results from different labs that perform prothrombin time

(PT) blood tests.

 

Prothrombin is a protein substance that must be converted to

thrombin in order for clotting to occur. The time this process takes

to form a clot is called the prothrombin time. A normal range is from

10 to 20 seconds. However, PT results can differ from lab to lab. The

INR allows physicians to reliably compare results from different labs.

While most labs report both INR and PT, INR has officially replaced PT

as the standard.

 

* Activated partial thromboplastin time (APTT or PTT). This test

measures all the coagulation reactions that occur inside the body

(intrinsic), except for platelet aggregation. It measures the time it

takes for a blood clot to form after an aggregating agent has been

added to the blood sample. Normal time ranges from 25 to 36 seconds.

 

* Bleeding time. A test in which three small scratches are made on

the patient's skin and then the time it takes for the bleeding to stop

is recorded. It is used to assess the integrity of platelet function.

 

* Activated clotting time (ACT). This test is primarily used to

measure a patient's clotting time before or during surgeries in which

a slower clotting rate is desired. The normal range is from 94 to 120

seconds. During operations such as bypass surgery, physicians give

their patients anticoagulants to slow their ACT to between 400 and 600

seconds.

 

* Platelet aggregation. Platelets (thrombocytes) are the smallest

type of blood cells. When an injury occurs, platelets clump together

(aggregate) to form a blood clot that will stop the bleeding. The

platelet aggregation test is one of several coagulation tests used to

measure the rate and degree to which the platelets (in a sample of

blood plasma) form clumps after the addition of a material that

stimulates aggregation.

 

* Plasma thrombin time (also called thrombin time or thrombin

clotting time). This is the time that it takes for clots to form in

the blood sample when a set amount of bovine (cattle) thrombin is

added to a sample of the patient's blood that has very few platelets.

It allows for a quick analysis of how much fibrinogen (Factor I) is in

the blood. Thrombin changes fibrinogen to fibrin, the main substance

that creates a blood clot. Normal thrombin time ranges from 10 to 15

seconds. A prolonged result will usually lead to additional more

specific testing, such as the one-stage factor assays.

 

* Plasma fibrinogen. This test directly measures the levels of

fibrinogen in the blood. Normal ranges are from 195 to 365 milligrams

per deciliter.

 

Factor-specific coagulation tests can help physicians pinpoint which

coagulation factor is causing a clotting problem. Deficiencies of a

particular clotting factor are often inherited, but some can be the

result of other illnesses. Factor-specific coagulation tests include

the following:

 

* One-stage factor assay. This test can determine which factor is

the cause of a coagulation problem. The actual testing procedure can

vary according to which clotting factor is being evaluated. The

patient's plasma is diluted and then mixed with another sample of

plasma in which the factor being tested is not present. The activity

of the mixture is then compared to the activity of the patient's

blood. Normal ranges vary from 50 to 150 percent. If the clotting time

for the mixture is longer than for the patient's blood then the

patient has a deficiency of that blood factor. This would be indicated

by a test result of less than 50 percent. The results of the PT and

APTT tests will determine which additional clotting factors need to be

tested, as shown below:

 

o When both PT and APTT are abnormally long, then factors in

the extrinsic coagulation system will be tested. These include factors

II, V or X.

 

o When PT is normal, but APTT is abnormal, factors in the

intrinsic coagulation system will be tested. These include factors

VIII, IX, XI or XII.

 

* Thromboplastin generation test (TGT). This test is used to

differentiate between factor VIII clotting problems (as seen in

hemophilia A) and factor IX clotting problems (as seen in hemophilia B).

 

* Fibrinopeptide A. This substance is released as a part of the

normal clotting process. This test is used to indicate the severity of

a clotting condition called disseminated intravascular coagulation

(DIC) – a serious bleeding disorder in which the clotting and

clot-dissolving properties in the body are activated not just at the

site of an injury, but throughout the entire body. Normal ranges vary

from 0.6 to 1.9 milligrams per milliliter.

 

Lysis tests evaluate the process by which blood clots are destroyed,

because blood clots are no longer necessary after the body has healed.

Blood clots provide a temporary but vital service in the body – they

inhibit the loss of blood through a wound so that the body has a

chance to heal. Since a blood clot is not needed forever, the body

eventually releases a substance called plasmin to break it up. The

following tests are used to evaluate this destruction process (lysis):

 

* Plasma plasminogen. Plasminogen is the inactive form of plasmin,

the substance that breaks up blood clots. Plasmin can only be measured

in its inactive form. Normal plasminogen levels range from 10 to 20

milligrams per deciliter. The value is sometimes expressed in units

per deciliter, in which case the normal ranges are from 80 to 120.

 

* Fibrin split products (or fibrin degradation products). The

products that are created during the break up of clots are called

fibrin split products. The presence and levels of fibrin split

products in the blood can give physicians valuable information about

the patient's coagulation status. Normal levels are 3 to 10 micrograms

per milliliter.

 

* Protein C. This substance is produced in the liver and inhibits

blood clotting by suppressing factors V and VIII. This test is made

only if others have not been able to determine the reason why patients

are prone to repeated blood clots. A deficiency of this protein is

rare, but may be the cause of unexplained blood clots. Normal ranges

from 70 to 140.

 

* Euglobulin lysis time (or lysis time). This test measures the

time interval between when a clot is formed to when it is dissolved.

Normal lysis time is at least two hours. Abnormally brief lysis time

indicates that the body is destroying blood clots too quickly, and

abnormally long lysis time indicates that the body is destroying blood

clots too slowly.

[Guest guest]

At 4:48 PM +0000 1/14/05, Bob Flaws wrote:

>There are a number of competitors in the health care marketplace who

>want to put the kibbosh on alternative medicine. These people have the

>ear of governmental regulators. There are also a lot of nervous

>Nellies out there, within and without our profession. Our competitors

>are using this issue to press for more control over our products and

>practices, and I think it is extremely important that we not buy into

>all of this.

--

Bob,

 

It seems to me that David Eisenberg is one of these people. He

appears to be working hard to subsume our practices into a medical

monopoly. Having important Chinese medicinals made unavailable to us,

our practices lose their flexibility and power, and therefore become

more marginal. The more marginal we are, the more we are separated

from our resources, the more the case can be made that our products

and practices can be cherry picked and used outside a Chinese medical

context.

 

You are right that this is a dangerous trend that appears to be

gathering pace, and that we need to respond to it forcefully.

 

Rory

--

 

 

 

[Guest guest]

Many Herbal Remedies May Interact With Popular Blood Thinner

webmd.com/content/article/27/1728_59275.htm

 

Researcher Amy M. Heck, PharmD, and colleagues found that three alternative

medicines -- coenzyme Q10, ginseng, and green tea -- have been shown to

decrease the effectiveness of Coumadin as a blood thinner. Five other

medicines -- vitamin E, papain, dong quai, devil's claw, and danshen -- all

have been shown to increase the blood thinning properties of Coumadin,

perhaps to dangerous levels... [other published articles include warnings

on: Dandelion, Chamomile, Ginger, St. John's Wort, Goldenseal, horse

chestnut, and Vitamin C. In my quick cursory search I did not find any

references to Garlic, Vinegar or Oils as possibilities, which IMO, a quick

lunch with Coumandin is not advised.]

 

Ginseng a No-No for Patients on Coumadin

webmd.com/content/article/90/100562.htm

" So a substance, such as ginseng, that alters [Coumadin's] effects -- even

slightly -- can have significant consequences. " University of Chicago

researcher Chun-Su Yuan, MD, PhD

 

 

The finger-is-pointing at -- any method not prescribed by an MD as being

dangerous. Herbalist will not be able to claim ignorance due to the

preponderance of [dis-]information " suggesting " a connection.

 

My opinion is that it is a good practice to be suspicious. As the Physicians

First Rule " Physician Do No Harm " .

Can we prescribe herbs, vitamins and minerals ? Indeed even life-style

changes do play an integral part here.

 

 

Singularly it may be possible to test possible interactions and also to

diligently monitor (at home, see below) possible outcomes. But Chinese

Herbal Formulas are not just a collection of individual herbs.

for example our friend Ma Huang. (available OTC as Rentamine, Rynatuss, Tuss

Tan)

ma huang + gui zhi = diaphoretic

ma huang + shi Gao = stops sweating

ma huang + xing ren = stops cough

ma huang + bai zhu = diuretic

 

At-Home Monitoring Works for People on Blood Thinners

webmd.com/content/article/26/1728_59089.htm

In a study published in the medical journal The Lancet, Dutch researchers

found there was virtually no difference between patients who managed their

own care at home and those who had it done at a clinic. In some ways, the

patients who monitored themselves at home did better than the ones seen at a

clinic, and most of them preferred self-treatment.

FDA approved Monitor = The ProTime System - PT-INR Testing. The ProTime®

Microcoagulation System for prothrombin time testing, PT-INR testing, is

designed to safely manage Coumadin® therapy. www.hometestmed.com

 

My question would be WHY are we treating these people?

More than likely for the adverse side affects of their Coumadin

prescriptions (published reports)

Abdominal Pain with Cramps, Alopecia, Diarrhea, Leukopenia, Nausea,

Vomiting, Acute Adrenocortical Insufficiency, Agranulocytosis, Allergic

Dermatitis, Aphthous Stomatitis, Edema, Feet Pain, Increased Risk of

Bleeding, Jaundice, Proteinuria, Pruritus of Skin, Renal Disease, Skin Rash,

Throat Ulceration, Urticaria.

NOT listed as adverse affects, but ones that appears in clinical practice

are the TCM diagnosis of Cold, Pain and fatigue. And a general vague feeling

that all is not well.

 

Once we decide we may be able to help. Do we treat the root or the branch ?

One certainty is that the At-Home monitoring system would make everyone a

little more comfortable.

 

 

Ed Kasper LAc. Licensed Acupuncturist & Herbalist

Acupuncture is a jab well done

www.HappyHerbalist.com Santa Cruz, CA.