Arterial Calcification From Warfarin: Vitamin K May Reverse it

The blood thinner, warfarin (Coumadin) is a “vitamin K-antagonist” which works by blocking vitamin K thereby affecting several steps in the anticoagulation pathway and decreasing clotting proteins in the blood.

But vitamin K is essential for heart and bone health. Without enough K-2, osteocalcin, a protein that binds calcium to bone, doesn’t function. “When calcium doesn’t stay in bones, it can end up clogging your arteries, causing a heart attack or stroke.” Vitamin K functions to keep calcium out of soft tissues.

In one study, people with the lowest blood levels of vitamin K-2 had a 57% greater risk of dying from heart disease than those with the highest levels. They were also at increased risk for osteoporosis and bone fractures.

Why I Warn Against Taking Warfarin

In a study of 451 women using mammograms to measure arterial calcification, after just one month of warfarin use, arterial calcification increased by 50% compared to untreated women. After five years, arterial calcification increased almost 3-fold.

To avoid arterial calcification, if you are on warfarin (Coumadin), talk to your doctor about switching to Eliquis (apixaban) which tested the best of the NOACs and has the best safety test results. (See my article, Warfarin and the New Anticoagulants.)

Research: Vitamin K Reverses Arterial Calcification from Warfarin

If you have been on warfarin for a while, you will be interested in the evidence that high doses of vitamin K may reverse arterial calcification.

An analysis of kidney failure patients on dialysis found over 50% had vascular calcification (one devastating side effect). A clinical study tested supplementation with vitamin K2 (MK-7) over a six-week period. In the group given 360 mcg of MK-7, the favorable response rate was a remarkable 93%. (When supplementation ceased, these high-risk patients were once again vulnerable to vascular calcification.)

An animal study involved groups of rats who were all initially fed a six-week diet of warfarin to induce calcium buildup in the blood vessels. This was followed by some groups receiving high-dose vitamin K1 or K2 (MK-4).

In six weeks, not only was there no further arterial calcium accumulation, there was a 37% reduction of previously accumulated arterial calcification. After 12 weeks, there was a 53% reduction. The high-dose vitamin K1 and K2 groups also showed a reversal in carotid artery stiffness.

Warfarin (brand name Coumadin) various dosages

If on Warfarin, You’re Deficient in Vitamin K

According to the U.S. Department of Agriculture (USDA), the recommended range of normal vitamin K intake ranges between 60-80 micrograms for women and 80-120 micrograms for men. (The typical recommended supplement dosage is 90 mcg females, 120 mcg males.)

Nearly everyone is deficient in vitamin K. While most of us may get just enough vitamin K from our diet to maintain adequate blood clotting, most of us should increase our intake of vitamin K through foods like leafy greens, or take vitamin K supplements.

But if you’re on warfarin, you are NOT getting enough vitamin K to protect you from arterial calcification and a variety of other heart health problems. And certainly not enough to reverse the effects of warfarin on soft tissue calcification.

Counteract Arterial Calcification: What Dosage of Vitamin K?

So the question arises, is there anything we can do to reverse arterial calcification? What amount of vitamin K should you be getting? Sadly, we don’t have enough human research as to the correct dosage, but we do have some indications.

Referring back to the study above with rats, the human equivalent of the vitamin K dose given to the rats is in the range of 52,000 mcg (52mg) to 97,000 MCG) (97mg) per day. Also, in Japan, a 45,000 mcg (45mg) daily dose of the MK-4 form of vitamin K2 is approved as a drug to treat osteoporosis. Admittedly, these are high doses compared to the dietary industry standards. 

Although the exact dosage of vitamin K is yet to be determined, one of the world’s top vitamin K researchers, Dr. Cees Vermeer recommends between 45 mcg and 185 mcg daily for adults. (LifeExtension magazine recommends 200 mcg.)

Consider a high quality MK-7 form of vitamin K2. And since vitamin K1 and MK-4 are inexpensive, it makes sense to include them to inhibit and possibly reverse as much arterial calcification as possible. One product to look at is Life Extension Super K with Advanced K2 Complex Softgels, 90-Count available from Amazon.com. David Holzman writes that he uses Whole Foods Vitamin K2 which is less expensive.

Balancing Vitamin K and Warfarin for Proper INR Ratio

People taking warfarin are often told to lower their intake of vitamin K foods like leafy greens, liver, etc., because they interfere with the anti-blood clotting effect of warfarin. Not true.

Prolific A-Fib blogger Dr John Mandrola (Dr. John M.), posted about misinformation surrounding warfarin patients and vitamin K. He wrote:

“I am so utterly tired of correcting this mistake….Patients on warfarin can indeed eat green vegetables; they should just eat them consistently. I have vegetarians who do beautifully on warfarin. The problem comes when people vary the weekly dose of vegetables.

So, if you and your doctor decide that you should take warfarin, take more vitamin K, not less! You can take vitamin K. The key is to be consistent on a daily schedule. If consumption of vitamin K does affect your INR, your doctor can always adjust the warfarin dosage.

Your Bottom Line Goal

If you continue to take warfarin, your goal is to maintain the highest healthy levels of vitamin K to counteract the effects of warfarin on your arterial and bone health.

If you change from warfarin to a NOAC, your goal is to restore your arterial and bone health from the effects of warfarin by maintaining the highest healthy levels of vitamin K.

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