Important anticoagulant precautions

Vitamin K and aspirin can have a critical impact on blood-thinning meds

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Blood-thinning medications can be impacted by vitamin K and aspirin-containing products.

The formation of a clot in the body is a complex process that involves multiple substances called “clotting factors.” Clotting factors are proteins made in the liver. Some of these proteins, however, cannot be created without vitamin K, a common vitamin found in:

  • cabbage
  • cauliflower
  • spinach
  • other leafy green vegetables

Because anticoagulants such as warfarin (also known as Coumadin® or Jantoven®) slow clot formation by competing with vitamin K, it’s important to maintain a consistent daily intake of vitamin K and to be aware of anticoagulant precautions. Each person’s warfarin dosage is related to the amount of vitamin K in his or her body. If you overload your system with vitamin K, you override the effectiveness of the blood-thinning medication. Continue reading

An aspirin a day … is it right for you?

Clearing the air on who benefits from a daily aspirin

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If you’ve had a heart attack, you should be taking a low-dose aspirin a day.

Aspirin is truly a wonder drug when it comes to coronary artery disease (CAD). But what about the Food and Drug Administration’s recently released statement saying an aspirin a day is only for a select few?

In medicine, we define our treatments for CAD as primary and secondary prevention measures.

Primary prevention

Patients who have never had a heart attack or do not have any formal diagnosis of CAD fall into what we refer to as the primary prevention group. In this group, we commonly further subdivide patients into low and high risk for developing CAD. The more risk factors a patient has (family history, diabetes, hypertension, high cholesterol), the higher his or her lifetime risk is for having a heart attack. Patients older than 50 who are at high risk for developing CAD might benefit from taking 81 mg of aspirin every morning.

Secondary prevention

Patients who have already had a heart attack or have been diagnosed with CAD fall into the secondary prevention category. In this group, our goal is to prevent a second cardiac event. Ideally, everyone in this group should be taking an aspirin a day. The current recommended dose is one or two baby aspirin (81 or 162 mg every morning). A higher aspirin dose (325 mg) doesn’t necessarily reduce the risk of another heart attack, but instead potentially increases a patient’s bleeding risk.

No “one size fits all”

It is difficult to come up with a blanket statement for all patients with respect to aspirin, as it also depends on a patient’s bleeding risk as well as other factors. If a patient has had a heart attack (and there are no contraindications for using aspirin), I encourage him or her to take 81 mg of aspirin every morning.

For the primary prevention group of patients (if there is no increased risk associated with taking aspirin, the patient has multiple cardiac risk factors and is age 50 or older), I prescribe 81 mg of aspirin every morning.

For all patients, I encourage you to discuss aspirin use with your doctor before starting. Finally, aspirin should be taken after breakfast to decrease stomach irritation.

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tobin_kenneth 150x150Dr. Kenneth Tobin is a clinical assistant professor for the Department of Internal Medicine and director in the Chest Pain Center at the University of Michigan. His specialty is cardiology, with clinical interests in the association of patent foramen ovale and stroke, patent foramen ovale and migraine, preventive cardiology and echocardiography.



Frankel-informal-vertical-sigThe University of Michigan Samuel and Jean Frankel Cardiovascular Center is the top-ranked heart and heart surgery program among Michigan hospitals. To learn more, visit our website at