Coumadin and Vitamin K

[pagandeva2000, LPN]

I have a question; I am reading that the current thread is not to specify how much foods with vitamin K to consume, but the consistency of the amount (day to day should be the same). Does this mean that we should suggest that they eat, say, a 1/2 cup of collard greens a day, or does this mean that we tell the patient that whatever amount they eat should be consistent, because the provider is prescribing based on the results of the INR and other factors, such as other medications? Literature provided at my job (and web sites that are reputable) are stating that people do not have to avoid foods containing Vitamin K, however the amount must be steady from day to day. Does this mean that the patient can have a plate full, so to speak, as long as this is done consistently? And, the patient should tell the provider if there are dietary changes so that the amount of Coumadin is altered to accomodate this...am I corrrect thus far, or am I way off base here?

Thanks, folks!

[jmgrn65, RN]

I think you are on the right track, if the patient consumes food regularly with vit k then should continue the way the eat and not change anything dramaticly.So if they eat collard greens 2-3 times a week then continue.

[leslie :-D]

yes pagan, have them continue w/their regular eating habits.

the coumadin dosages are partly based on this norm.

leslie

[pagandeva2000, LPN]

Greatly appreciated! This came up because of my jerk off administrator telling us that we are teaching the wrong thing (JCAHO is here, you know how that goes...). I read a few sites that stated this, and therefore, I felt comfortable teaching this to the patients. The physician assistant that works there told me this, and suddenly this boob tube tells us that we should be telling them to eat a certain amount, like a cup of this or that. I appreciate your responses...I feel better.

[GrumpyRN63, ADN, RN]

What's worse is when people teach them they have to avoid all green leafy veges cause they interfere w/coumadin, and people listen and don't eat them for what 6 months, years??? crazy, eat, be consistent. I had a pt last week who thought she couldn't eat red meat w/coumadin , the misconception is amazing

[CardioTrans, BSN, RN]

You could always use the "well new research shows" line........... and yes, now it is taught that if you eat green leafy veggies once a week, keep eating that.........if you eat them daily, continue to eat them daily.

[pagandeva2000, LPN]

You could always use the "well new research shows" line........... and yes, now it is taught that if you eat green leafy veggies once a week, keep eating that.........if you eat them daily, continue to eat them daily.

That was what I got when reading the material...be consistent with whatever you are doing. If you suddenly decide to become a vegetarian, tell your doctor. It is a misconception based on what I have read in recent literature. It is amazing how this administrator believed that it had to be portioned.

Can I also assume that if a person normally drinks green tea on a daily basis can continue to do so? Also, I have a list of foods that catagorizes the vitamin K content as Low, Medium and High. Is that worth giving to the patient or has that changed as well. I stopped giving that particular one based on what I read in recent journals. I was under the impression that when people get this list, they decide that they will no longer eat the asparagus that they love, or cabbage, because it has a high content of vitamin K, and I didn't want to start confusing or overwhelming them. Thoughts? Again, thank you everyone for your time and input.

[ilstu99]

On our cardiac floor where I did clinicals, there was a "perfect world" answer and the "real world" answer.

In a perfect world, the MDs will follow-up well, calculate the coumadin based on lab values until they find a good match, and continue to monitor the levels regularly.

In the real world, many of the patients walk out of the unit and never show-up for their follow-ups, or the lazy MDs don't routinely test and adjust, and everyone gets about the same dosage.

So.....we would tell them not to start gobbling up greens if they usually didn't, and give them a list of high vit K foods so they're "informed" when considering making changes.....while we schedule their lab appointments for the next 2 months and encourage them to show-up.

[JBudd, MSN]

The amounts should be consistent daily, because your dose is daily (usually). When I was on coumadin, I tended to avoid the dark greens because I habitually only ate them when I got Chinese Broccoli with Beef, which was certainly not daily!

People should be dosed according to their personal dietary habits, because very few will change their habits long term. We need to fit our care into thier lives, not thier lives into what we think is best.