![]() ![]() © 2015 by The American Society of Hematology. Although these patients initially present to various medical specialties, the hematologist is often consulted to offer the definitive diagnosis and proper therapy. Treatment with large doses of oral vitamin K1, often over months to years, to maintain a near-normal prothrombin time can reverse the coagulopathy associated with superwarfarins. Immediate diagnosis and proper therapy is critically important to minimize morbidity and mortality because this condition, affecting thousands of patients annually, is reversible. Other foods that could affect warfarin are beef liver or other animal liver products. Foods with vitamin K that could affect warfarin are listed on the next 2 pages. ![]() These rodenticides are readily available household environmental hazards and are sometimes consumed accidentally or as manifestations of psychiatric disease. The most common foods with high vitamin K are green leafy vegetables such as kale, collard greens, broccoli, spinach, cabbage, and lettuce. Superwarfarins are 2 orders of magnitude more potent than warfarin and have a half-life measured in weeks. Serious bleeding manifestations are common. Severe deficiency of vitamin K-dependent proteins in patients not maintained on vitamin K antagonists is most commonly associated with poisoning by or surreptitious ingestion of warfarin, warfarin-like anticoagulants, or potent rodenticides ("superwarfarins"), such as brodifacoum. ![]()
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