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Reducing Coumadin Risk
Through Genetic Testing
Podcast by Robert Rodvien, M.D. (April 13, 2009)
Dr. Robert Rodvien identifies some reasons why people need different doses of Coumadin. This podcast emphasizes that certain genes control how Coumadin is broken down by the body and how Vitamin K is recycled. These two genes can vary from person to person and therefore they can make us all differently sensitive to Coumadin, a difference that may explain why some people have bleeding issues with Coumadin within the first month of receiving the drug. Still, there are other variables --- perhaps other genes --- that affect how sensitive any individual is to Coumadin. Scientists call these families of genes CYP2C9 and VCOR. They can be analyzed in the blood or saliva. The genes are not related to each other but, because Coumadin and Vitamin K offset the action of each other, the two proteins produced by the genes can interact to alter the effectiveness of the Coumadin.
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Reduced Effectiveness of Plavix in Patients Who Are Poor Metabolizers of the Drug
Chris Jones, Division of Drug Information (March 17, 2010)
Welcome, my name is Chris Jones, a pharmacist in the Division of Drug Information. Today I am updating you about reduced effectiveness of Plavix in patients who are poor metabolizers of the drug. The U.S. Food and Drug Administration (FDA) has added a Boxed Warning to the drug label for Plavix. Because Plavix is a pro-drug, it must be converted in the liver to its active form and CYP2C19 is the predominate enzyme responsible for this conversion. Patients who are poor metabolizers of Plavix, do not effectively convert the drug to its active form. In these patients, Plavix has less effect on platelets, and therefore less ability to prevent heart attacks, strokes, and cardiovascular death.
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Michelle Hamman on Iverson's
Warfarin Dosing Panel
You Tube video featuring Michelle Hamman
Michelle Hamman RN, Director of the Coumadin Clinic at Columbia Heart, Columbia, SC - takes time out of her busy schedule to communicate the benefits of the Iverson Warfarin Dosing Panel and its impact on the patients she serves.
Click here to Watch
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Genetic Testing and Cancer
Podcast by Robert Rodvien, M.D. (September 18, 2007)
Some day, we may be able to conduct genetic testing for most cancers. As of now, there are limited tests available for some cancers and, even then, there's no definitive course of action dictated by the results. In this episode of Smarter Cancer Care, Dr. Rodvien discusses genetic testing for breast and ovarian cancer, the pros and cons, genetic counseling, and how women with a significant incidence of these cancers in their families might proceed.
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Clotting and Anti-Coagulation Clinics
Podcast by Robert Rodvien, M.D. (June 5, 2008)
For patients who have experienced blood clots, there's much to know about lifestyle changes and proper medication. In this episode of Smarter Medical Care, Hematologist/Oncologist Dr. Robert Rodvien, founder of the Coumadin Clinic at the California Pacific Medical Center in San Francisco, discusses deep vein thrombosis and the relative merits of anti-coagulation clinics.
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Interview with Kendra Keys of
the Swank MS Foundation
You Tube video by John Baek
The Swank MS Foundation is a private charity that provides information and resources on the Swank Low Fat Diet, vitamin supplements, and life-style changes beneficial to patients with Multiple Sclerosis, as well as their families and friends, as pioneered by Roy L. Swank, M.D., Ph.D. In this You Tube video, Iverson's John Baek interviews Kendra Keys, Administrator for the Swank MS Foundation where they discuss Multiple Sclerosis and the partnership between the two organizations.
Click here to Watch
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How Coumadin Interacts
With
Other Medicines
Podcast by Robert Rodvien, M.D. (March
30, 2009)
For any given person, any
medicine can cause you to be more or less sensitive to Coumadin. Some
of the drugs to remember are pain relievers (especially aspirin),
antibiotics, and medicines to keep stents open (like Plavix). If you
need one of these drugs, talk with your physician. If your physician
prescribes a medicine, remind him or her you are taking Coumadin. If you
intermittently take Chinese herbs, make sure you get frequent blood
tests. (You probably should get blood tests every 4 weeks or more
frequently, even if the INR is stable and no medicines have been started
or stopped.) If there are concerns that the Coumadin effect may be
changed, get an INR. Although the effect of most medicines is to
increase your risk to bleed from Coumadin, some medicines can decrease
the effect of Coumadin to slow clotting. That effect can also be
estimated by doing the same blood test ---the INR.
Click here to
Listen
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