Dr. C replied: "Patients with mechanical mitral valves (vs. bioprosthetic) need life-long anticoagulation because they may have a high rate of red blood cell destruction due to valve-blood interactions. Aspirin alone is not enough. Patients with bioprosthetic valves (tissue valves) generally do not need warfarin (Coumadin).
Warfarin works by preventing the body from turning vitamin K into various clotting factors. Its effectiveness is measured by an INR. Vitamin K is found in green leafy vegetables. As a result, eating a diet high in vitamin K may make the warfarin less effective, requiring a higher dose.
However, contrary to most doctor's beliefs, patients should NOT completely avoid eating vitamin K sources when on warfarin. It is true that patients with low vitamin K intake need lower Coumadin doses to achieve a therapeutic INR. However, they are more likely to have an unstable INR, spend less time in a therapeutic INR range, and at higher risk for complications due to a very high INR (bleeding) or very low INR (clotting, red blood cell destruction). Patients should continue to eat regular, small amounts and avoid large meals of these vegetables. A 1/2 cup of spinach is enough to alter your INR. In fact, there is even evidence that regular supplementation with vitamin K can improve INR stability.
You or your acquaintance should discuss her concerns with her physician."
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