Coumadin Dosage

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Rat poison. Yes, rat poison. Until recently it was the ONLY drug (which means something different from the drug of choice) to counter potential blood clotting in humans who undergo dialysis and/or transplantation.  Other folks took the drug to avoid cardiovascular complications because they had artificial heart valves or a condition called atrial fibrillation, among other situations.

I‘ve advocated many folks stop taking this in favor of the newer drugs. Now, I might have to temper that request. First, lets recall the the problems with Coumadin. The degree of kidney functionality changes the appropriate dose (or effectiveness). And, women who have not experienced menopause have no means to discern the proper dose as their hormonal levels change.  (We determine the proper dosage by examining the blood clotting time- and then guess as to how much to alter the dosage if the clotting time is not appropriate.)

Warfarin and Vitamin K

But, Coumadin (warfarin) is also known to inhibit tumorigenesis (by affecting the AXL receptor, tyrosine kinase) and to enhance the immune response (even when the dosage is below the anti-coagulation levels). Admittedly, we don’t yet fully understand the mechanisms (other than the interference with vitamin K related activity) of this effect, but the end result is that Coumadin reduces the risk of developing cancer.

Coumadin Dosage

Drs. G.S. Haaland, O. Straume, and J. Loren of the University of Bergen, along with Dr. R.S. Falk of Oslo University Hospital analyzed the data collected from some 1.2 million Norwegian adults, all of whom were over the age of 50. They presented their analysis in JAMA (the Journal of the American Medical Association)  .

Of the 1,256,725 subjects, 649375 were male, and 132687 manifested cancer symptoms.  Within the subject pool,  a total of 92942 patients had been taking Coumadin for about 5 years.  The  mean age of the pool was 70 (compared to 63.9 who were not on Coumadin), of which this specific cohort was 62% male. (The non-users were 53% female.)

During the course of the analytic period, some 133,000 subjects developed cancer. Only 8754 (9.4%) of those taking warfarin (the generic name for Warfarin) manifested cancer symptoms, compared to the 10.6% (123,933) in the non-user cohort. Those differences sound widely more successful if we (as some newspapers are wont to do) note those taking Warfarin were, therefore, about 16% less likely to develop cancers of any type. (But the differences among individual types of cancer incidences were far more substantial.  Prostate cancer was reduced by 31%, lung cancer by 20%,; yet the incidence of breast cancer was only reduced by 10%.   Oh, and there was no difference in the incidence of skin cancer or colorectal cancer.)

Note, however, that the TOTAL cancer incidence with the population was slightly above 1% for the whole population. And, the study did not examine data on lifestyle factors (diet, weight, smoking habits), either,because the raw data did not include same. Nor was there any notation of the effect of co-medications the subjects employed.

So, I won’t be rushing off to take warfarin (Coumadin) anytime soon.  What about you?

Roy A. Ackerman, Ph.D., E.A.

 

Uh-oh!  Don’t tell me you haven’t signed onto your Medicare Advantage or Part D (for drugs) insurance yet?  If you’re 65, tomorrow’s the last day.  And, if you are under 65, then you’ve got 9 days to pick the best PPACA/Obamacare option to cover yourself and your family.   (As of now, there still is a 2.5% penalty if you don’t get yours!)

Open Season 4 Dummies

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