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IMPORTANT INFO: Taking CoQ10 with blood thinners

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  • Carol
    My mom was just diagnosed with Atrial Fibrilation, her upper chamber of her heart is enlarged and she has an irregular heart beat. She was prescribed Warfarin
    Message 1 of 14 , Jan 28, 2009
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      My mom was just diagnosed with Atrial Fibrilation, her upper chamber
      of her heart is enlarged and she has an irregular heart beat. She
      was prescribed Warfarin (Coumadin) blood thinner to prevent clotting.

      On the info from the drug handout, it says to NOT take CoQ10 with
      blood thinners, because it interferes with the anti-clotting action
      of the Warfarin/Coumadin.

      Well, I did some checking, because I couldn't believe that this was
      true. I've been giving my heart kitties blood thinners (either drugs
      or nattokinase) for years and also giving them CoQ10. I was shocked
      at what I found today, and I think everyone needs to know about
      this, so they can do their own research and make their own
      decisions. I'm still trying to find out more too.

      CoQ10 supposedly is structurally related to Vitamin K, which
      enhances clotting in the blood, so if you're taking a blood thinner,
      you DO NOT want to take Vitamin K. Well, if CoQ10 has clotting
      properties, then we should not be giving it to our kitties either!
      Right?! I'm very confused and upset about my findings today.

      Here's one site that I found with info, and there are tons more. I
      did a Google search for "interactions with coumadin and CoQ10".
      That's how I found these. Now what I found is related to
      specifically Warfarin/coumadin, but it applies to all blood
      thinners, including nattokinase.

      http://www.medscape.com/viewarticle/409742_10
      Coenzyme Q10 is structurally related to vitamin K and subsequently
      possesses procoagulant effects. The potentially critical interaction
      can result as a diminished response to warfarin therapy. Several
      case reports describe decreases in international normalized ratio
      (INR) after the addition of CoQ10 in patients previously stabilized
      with warfarin therapy.[59, 60] With discontinuation of CoQ10,
      responsiveness to warfarin therapy resumed and INR values returned
      to levels seen prior to provitamin supplementation.[59, 60] The
      concomitant use of warfarin and CoQ10 should be avoided due to the
      risk of thrombotic complications.

      http://www.annieappleseedproject.org/specnatsubin.html
      Coenzyme Q10 (also known as ubiquinone or ubidecarenone) is used for
      congestive heart failure and other cardiovascular disorders.[5] It
      can reduce the anticoagulant effect of warfarin. There have been two
      case reports describing decreased International Normalized Ratios
      (INRs) when coenzyme Q10 was added to warfarin therapy on which
      patients had been stable.[21,22]

      In animals, coenzyme Q10 antagonizes the anticoagulant effects of
      warfarin.[23] Coenzyme Q10 is structurally related to men-aquinone
      (vitamin K2), suggesting a pharmacodynamic interaction with warfarin.
      [21,23]


      Here are some sites with info about herb/supplement interactions
      with blood thinners (specifically Warfarin/coumadin).

      http://www.healthchemist.co.nz/learning-centre.html?
      org=commodore&ContentID=1539003 or http://tinyurl.com/cr4ehq

      This site states that if you're already taking CoQ10 supplementation
      to "not" stop it when you start taking blood thinners (coumadin).

      http://tinyurl.com/caj8kv
      Coenzyme Q10 (ubidecarenone) resembles vitamin K (chemically) and
      may also reduce the effectiveness of warfarin.10 If a patient is
      already taking Coenzyme Q10, then discontinuing supplementation of
      CoQ is not recommended before initiating warfarin therapy. However,
      it is advisable not to initiate CoQ supplementation in a patient
      starting warfarin dosing.



      There are also other herbs that interfere with blood thinners,
      including chamomile and ginko biloba. Of course there's the usual
      food things like onions and garlic that thin the blood, which we
      don't give our kitties, because of them causing Heinz Bodies Anemia,
      so those we don't worry too much about, but I also found out that
      Ginger also thins the blood and can increase the risk of internal
      bleeding if taking blood thinners. This is very upsetting to me,
      because we use ginger all the time for my mom for digestion and
      stomach upset.

      I've been interested in and studying holistic and alternative
      treatments for several years, since the early 1980's, and I've never
      come across this info about CoQ10 and blood thinners. Now that I
      have, I'm concerned about how to treat Snowball's heart issues, and
      worried about all of our kitties on this group who have to take
      blood thinners and are taking CoQ10.

      Can someone on the group who is very knowledgable about the
      CoQ10/blood thinners interactions please chime in here and give us
      some more information? This is a very serious thing I found out
      today, and had my mom not just been diagnosed with her heart
      problems, I'd have never known this about CoQ10 (it having clotting
      properties).

      Now, I don't want to panic anyone and have you all stop your CoQ10
      that you're giving your kitties. You CAN NOT just stop CoQ10 cold
      turkey. You have to slowly wean off of it. Stopping it cold can
      result in negative affects on the heart. The heart muscle gets used
      to a certain inflow of CoQ10, helping it function properly (CoQ10
      helps strengthen the heart muscles), and if you take that away
      suddenly, you have the risk of the heart going into failure because
      it's not getting an adequate supply of CoQ10. The body does produce
      a certain amount of CoQ10, but as you age or have illness, the
      body's manufacture of CoQ10 decreases, that's why we supplement.
      So, if you are going to stop your CoQ10, please do it very slowly.

      Again, members who know more about this drug/CoQ10 interaction,
      please add your thoughts.

      {sigh}

      hugs,
      Carol and Snowball and the gang
    • dshale1
      I am interested in this warning as well. Our cat is on Plavix, which is somewhat more forgiving than warfarin or heparin, but it does say in the warnings that
      Message 2 of 14 , Feb 2, 2009
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        I am interested in this warning as well. Our cat is on Plavix, which
        is somewhat more forgiving than warfarin or heparin, but it does say
        in the warnings that CoQ10 may affect Plavix' effectiveness. I have
        decided to gradually reduce the amount of CoQ10 we have been
        giving--we had been giving the contents of a 100 mg capsule twice a
        day in her food, on the theory that she doesn't eat it all, but we are
        going to go back to once a day, and not at the same time of day she
        gets her Plavix.

        In Pye's case I don't think the CoQ10 has helped much anyway, since
        she has progressed so fast, and I think at this point her risk of a
        blood clot is greater than any small benefit CoQ10 might provide. We
        will reduce the amount gradually but as I said, she doesn't always eat
        it anyway and pretty much never eats the whole amount.
        -Susan

        --- In feline-heart@yahoogroups.com, "Carol" <carolroars@...> wrote:
        >
        > My mom was just diagnosed with Atrial Fibrilation, her upper chamber
        > of her heart is enlarged and she has an irregular heart beat. She
        > was prescribed Warfarin (Coumadin) blood thinner to prevent clotting.
        >
        > On the info from the drug handout, it says to NOT take CoQ10 with
        > blood thinners, because it interferes with the anti-clotting action
        > of the Warfarin/Coumadin.
        >
        > Well, I did some checking, because I couldn't believe that this was
        > true. I've been giving my heart kitties blood thinners (either drugs
        > or nattokinase) for years and also giving them CoQ10. I was shocked
        > at what I found today, and I think everyone needs to know about
        > this, so they can do their own research and make their own
        > decisions. I'm still trying to find out more too.
        >
        > CoQ10 supposedly is structurally related to Vitamin K, which
        > enhances clotting in the blood, so if you're taking a blood thinner,
        > you DO NOT want to take Vitamin K. Well, if CoQ10 has clotting
        > properties, then we should not be giving it to our kitties either!
        > Right?! I'm very confused and upset about my findings today.
        >
        > Here's one site that I found with info, and there are tons more. I
        > did a Google search for "interactions with coumadin and CoQ10".
        > That's how I found these. Now what I found is related to
        > specifically Warfarin/coumadin, but it applies to all blood
        > thinners, including nattokinase.
        >
        > http://www.medscape.com/viewarticle/409742_10
        > Coenzyme Q10 is structurally related to vitamin K and subsequently
        > possesses procoagulant effects. The potentially critical interaction
        > can result as a diminished response to warfarin therapy. Several
        > case reports describe decreases in international normalized ratio
        > (INR) after the addition of CoQ10 in patients previously stabilized
        > with warfarin therapy.[59, 60] With discontinuation of CoQ10,
        > responsiveness to warfarin therapy resumed and INR values returned
        > to levels seen prior to provitamin supplementation.[59, 60] The
        > concomitant use of warfarin and CoQ10 should be avoided due to the
        > risk of thrombotic complications.
        >
        > http://www.annieappleseedproject.org/specnatsubin.html
        > Coenzyme Q10 (also known as ubiquinone or ubidecarenone) is used for
        > congestive heart failure and other cardiovascular disorders.[5] It
        > can reduce the anticoagulant effect of warfarin. There have been two
        > case reports describing decreased International Normalized Ratios
        > (INRs) when coenzyme Q10 was added to warfarin therapy on which
        > patients had been stable.[21,22]
        >
        > In animals, coenzyme Q10 antagonizes the anticoagulant effects of
        > warfarin.[23] Coenzyme Q10 is structurally related to men-aquinone
        > (vitamin K2), suggesting a pharmacodynamic interaction with warfarin.
        > [21,23]
        >
        >
        > Here are some sites with info about herb/supplement interactions
        > with blood thinners (specifically Warfarin/coumadin).
        >
        > http://www.healthchemist.co.nz/learning-centre.html?
        > org=commodore&ContentID=1539003 or http://tinyurl.com/cr4ehq
        >
        > This site states that if you're already taking CoQ10 supplementation
        > to "not" stop it when you start taking blood thinners (coumadin).
        >
        > http://tinyurl.com/caj8kv
        > Coenzyme Q10 (ubidecarenone) resembles vitamin K (chemically) and
        > may also reduce the effectiveness of warfarin.10 If a patient is
        > already taking Coenzyme Q10, then discontinuing supplementation of
        > CoQ is not recommended before initiating warfarin therapy. However,
        > it is advisable not to initiate CoQ supplementation in a patient
        > starting warfarin dosing.
        >
        >
        >
        > There are also other herbs that interfere with blood thinners,
        > including chamomile and ginko biloba. Of course there's the usual
        > food things like onions and garlic that thin the blood, which we
        > don't give our kitties, because of them causing Heinz Bodies Anemia,
        > so those we don't worry too much about, but I also found out that
        > Ginger also thins the blood and can increase the risk of internal
        > bleeding if taking blood thinners. This is very upsetting to me,
        > because we use ginger all the time for my mom for digestion and
        > stomach upset.
        >
        > I've been interested in and studying holistic and alternative
        > treatments for several years, since the early 1980's, and I've never
        > come across this info about CoQ10 and blood thinners. Now that I
        > have, I'm concerned about how to treat Snowball's heart issues, and
        > worried about all of our kitties on this group who have to take
        > blood thinners and are taking CoQ10.
        >
        > Can someone on the group who is very knowledgable about the
        > CoQ10/blood thinners interactions please chime in here and give us
        > some more information? This is a very serious thing I found out
        > today, and had my mom not just been diagnosed with her heart
        > problems, I'd have never known this about CoQ10 (it having clotting
        > properties).
        >
        > Now, I don't want to panic anyone and have you all stop your CoQ10
        > that you're giving your kitties. You CAN NOT just stop CoQ10 cold
        > turkey. You have to slowly wean off of it. Stopping it cold can
        > result in negative affects on the heart. The heart muscle gets used
        > to a certain inflow of CoQ10, helping it function properly (CoQ10
        > helps strengthen the heart muscles), and if you take that away
        > suddenly, you have the risk of the heart going into failure because
        > it's not getting an adequate supply of CoQ10. The body does produce
        > a certain amount of CoQ10, but as you age or have illness, the
        > body's manufacture of CoQ10 decreases, that's why we supplement.
        > So, if you are going to stop your CoQ10, please do it very slowly.
        >
        > Again, members who know more about this drug/CoQ10 interaction,
        > please add your thoughts.
        >
        > {sigh}
        >
        > hugs,
        > Carol and Snowball and the gang
        >
      • Kathy Wood
        Sangie has been taking CoQ10 for many years. She started heperin treatment in Sept 2008 & I had no idea of the possible adverse affects it might have. I
        Message 3 of 14 , Feb 2, 2009
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          Sangie has been taking CoQ10 for many years. She started heperin
          treatment in Sept 2008 & I had no idea of the possible adverse affects
          it might have. I guess I'll start weaning her off the CoQ.
          Thanks so much for this post.
          k-

          Carol wrote:

          > My mom was just diagnosed with Atrial Fibrilation, her upper chamber
          > of her heart is enlarged and she has an irregular heart beat. She
          > was prescribed Warfarin (Coumadin) blood thinner to prevent clotting.
          >
          > On the info from the drug handout, it says to NOT take CoQ10 with
          > blood thinners, because it interferes with the anti-clotting action
          > of the Warfarin/Coumadin.
          >
          > Well, I did some checking, because I couldn't believe that this was
          > true. I've been giving my heart kitties blood thinners (either drugs
          > or nattokinase) for years and also giving them CoQ10. I was shocked
          > at what I found today, and I think everyone needs to know about
          > this, so they can do their own research and make their own
          > decisions. I'm still trying to find out more too.
          >
          > CoQ10 supposedly is structurally related to Vitamin K, which
          > enhances clotting in the blood, so if you're taking a blood thinner,
          > you DO NOT want to take Vitamin K. Well, if CoQ10 has clotting
          > properties, then we should not be giving it to our kitties either!
          > Right?! I'm very confused and upset about my findings today.
          >
          > Here's one site that I found with info, and there are tons more. I
          > did a Google search for "interactions with coumadin and CoQ10".
          > That's how I found these. Now what I found is related to
          > specifically Warfarin/coumadin, but it applies to all blood
          > thinners, including nattokinase.
          >
          > http://www.medscape.com/viewarticle/409742_10
          > <http://www.medscape.com/viewarticle/409742_10>
          > Coenzyme Q10 is structurally related to vitamin K and subsequently
          > possesses procoagulant effects. The potentially critical interaction
          > can result as a diminished response to warfarin therapy. Several
          > case reports describe decreases in international normalized ratio
          > (INR) after the addition of CoQ10 in patients previously stabilized
          > with warfarin therapy.[59, 60] With discontinuation of CoQ10,
          > responsiveness to warfarin therapy resumed and INR values returned
          > to levels seen prior to provitamin supplementation.[59, 60] The
          > concomitant use of warfarin and CoQ10 should be avoided due to the
          > risk of thrombotic complications.
          >
          > http://www.annieappleseedproject.org/specnatsubin.html
          > <http://www.annieappleseedproject.org/specnatsubin.html>
          > Coenzyme Q10 (also known as ubiquinone or ubidecarenone) is used for
          > congestive heart failure and other cardiovascular disorders.[5] It
          > can reduce the anticoagulant effect of warfarin. There have been two
          > case reports describing decreased International Normalized Ratios
          > (INRs) when coenzyme Q10 was added to warfarin therapy on which
          > patients had been stable.[21,22]
          >
          > In animals, coenzyme Q10 antagonizes the anticoagulant effects of
          > warfarin.[23] Coenzyme Q10 is structurally related to men-aquinone
          > (vitamin K2), suggesting a pharmacodynamic interaction with warfarin.
          > [21,23]
          >
          > Here are some sites with info about herb/supplement interactions
          > with blood thinners (specifically Warfarin/coumadin).
          >
          > http://www.healthchemist.co.nz/learning-centre.html?
          > <http://www.healthchemist.co.nz/learning-centre.html?>
          > org=commodore&ContentID=1539003 or http://tinyurl.com/cr4ehq
          > <http://tinyurl.com/cr4ehq>
          >
          > This site states that if you're already taking CoQ10 supplementation
          > to "not" stop it when you start taking blood thinners (coumadin).
          >
          > http://tinyurl.com/caj8kv <http://tinyurl.com/caj8kv>
          > Coenzyme Q10 (ubidecarenone) resembles vitamin K (chemically) and
          > may also reduce the effectiveness of warfarin.10 If a patient is
          > already taking Coenzyme Q10, then discontinuing supplementation of
          > CoQ is not recommended before initiating warfarin therapy. However,
          > it is advisable not to initiate CoQ supplementation in a patient
          > starting warfarin dosing.
          >
          > There are also other herbs that interfere with blood thinners,
          > including chamomile and ginko biloba. Of course there's the usual
          > food things like onions and garlic that thin the blood, which we
          > don't give our kitties, because of them causing Heinz Bodies Anemia,
          > so those we don't worry too much about, but I also found out that
          > Ginger also thins the blood and can increase the risk of internal
          > bleeding if taking blood thinners. This is very upsetting to me,
          > because we use ginger all the time for my mom for digestion and
          > stomach upset.
          >
          > I've been interested in and studying holistic and alternative
          > treatments for several years, since the early 1980's, and I've never
          > come across this info about CoQ10 and blood thinners. Now that I
          > have, I'm concerned about how to treat Snowball's heart issues, and
          > worried about all of our kitties on this group who have to take
          > blood thinners and are taking CoQ10.
          >
          > Can someone on the group who is very knowledgable about the
          > CoQ10/blood thinners interactions please chime in here and give us
          > some more information? This is a very serious thing I found out
          > today, and had my mom not just been diagnosed with her heart
          > problems, I'd have never known this about CoQ10 (it having clotting
          > properties).
          >
          > Now, I don't want to panic anyone and have you all stop your CoQ10
          > that you're giving your kitties. You CAN NOT just stop CoQ10 cold
          > turkey. You have to slowly wean off of it. Stopping it cold can
          > result in negative affects on the heart. The heart muscle gets used
          > to a certain inflow of CoQ10, helping it function properly (CoQ10
          > helps strengthen the heart muscles), and if you take that away
          > suddenly, you have the risk of the heart going into failure because
          > it's not getting an adequate supply of CoQ10. The body does produce
          > a certain amount of CoQ10, but as you age or have illness, the
          > body's manufacture of CoQ10 decreases, that's why we supplement.
          > So, if you are going to stop your CoQ10, please do it very slowly.
          >
          > Again, members who know more about this drug/CoQ10 interaction,
          > please add your thoughts.
          >
          > {sigh}
          >
          > hugs,
          > Carol and Snowball and the gang
          >
          >


          --
          Kathy Wood
          Executive Program Manager
          UNC-Chapel Hill AGEP
          Department of Chemistry
          Kenan Labs, CB#3290
          p) 919.962.2509
          f) 919.843.2554
          kathy_wood@...

          www.unc.edu/agep
          www.acsbe.org
          www.unc.edu/opt-ed
        • Monika Delle
          I wonder if CoQ10 has a reaction with aspirin? It thins the blood and one of my girls is taking it for arthritis. She doesn t need the blood thinning
          Message 4 of 14 , Feb 2, 2009
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            I wonder if CoQ10 has a reaction with aspirin? It thins the blood and
            one of my girls is taking it for arthritis. She doesn't need the blood
            thinning properties yet. Anyone have an educated guess?

            Monika

            Kathy Wood wrote:
            >
            > Sangie has been taking CoQ10 for many years. She started heperin
            > treatment in Sept 2008 & I had no idea of the possible adverse affects
            > it might have. I guess I'll start weaning her off the CoQ.
            > Thanks so much for this post.
            > k-
            >



            [Non-text portions of this message have been removed]
          • Carol
            hi Monika, I don t know what reactions CoQ10 has with the thinners. The only thing that I found out was that CoQ10 has vitamin K-like properties . That s all
            Message 5 of 14 , Feb 2, 2009
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              hi Monika,

              I don't know what reactions CoQ10 has with the thinners. The only
              thing that I found out was that CoQ10 has "vitamin K-like
              properties". That's all I could find in all my searching. So does
              that mean that it thickens the blood? I'm not sure, and if it does,
              how much? I'm hoping someone who knows more about this will speak up
              on this topic.

              As far as giving aspirin for arthritis, would not do that for a cat.
              Aspirin is toxic to cats and dogs, can give them liver problems and
              even can kill them if the doses are too high. There are much better
              choices for treating arthritis than aspirin. I had my angel Sadie, an
              English Springer Spaniel, back in the early 1990's, who had hip
              displasia and arthritis, the vet prescribed aspirin and I gave that to
              her for about a year, then she developed liver problems and internal
              bleeding from the aspirin. I don't like using aspirin at all, even
              for heart kitties. I much rather use Nattokinase for blood thinning
              than aspirin.

              Anyway, for the arthritis, you can try glucosamine/chondroitin, MSM,
              sea cucumber...these are all supplements that are safe for animals to
              use for arthritis. When my older guys (all angels now) had arthritis,
              I used a liquid glucosamin/chondroitin/MSM supplement called Healthy
              Drops. I'm sure there are others that work too, but I had good luck
              with that one. Here's a place online that has it. I buy it at my local
              pet store (not Petco or Petsmart though, they don't carry it). The
              smaller independent stores sometimes have it.
              http://www.detour23.com/k9liquidhealth/#hdg

              I'm sorry to have put out this alarm with the CoQ10/blood thinners
              thing, but I really hope we can find out the skinny on this. I hate to
              think that something that does so much good can be potentially bad for
              our kitties.

              hugs,
              Carol and Snowball and the gang





              --- In feline-heart@yahoogroups.com, Monika Delle <lotsacats@...>
              wrote:
              >
              > I wonder if CoQ10 has a reaction with aspirin? It thins the blood
              and one of my girls is taking it for arthritis. She doesn't need the
              blood thinning properties yet. Anyone have an educated guess?
              >
              > Monika
              >
            • Carol
              Hi Kathy, I wouldn t stop the CoQ10 if Sangie has been on it for that many years. Since her system is used to whatever the effects are of the CoQ10, her blood
              Message 6 of 14 , Feb 2, 2009
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                Hi Kathy,

                I wouldn't stop the CoQ10 if Sangie has been on it for that many
                years. Since her system is used to whatever the effects are of the
                CoQ10, her blood would be "normal" for her prior to the heparin
                treatment. I mean, her blood clotting factors are the "normal" that
                they are "with" her taking CoQ10, way prior to her ever getting
                heparin. So her heparin dose and frequency was given to her with her
                body "used to" whatever the CoQ10 may contribute as far as clotting
                factors. It's like someone whe eats a lot of veggies with vitamin K
                in them, things like green leafy veggies and cruciferous (broccoli,
                etc.). If they've always eaten those things and then have to be put
                on blood thinners, the thinners are based on what their bodies are
                currently getting. But if they're not used to having those things,
                they shouldn't "start" eating veggies with vitamin K, because that
                would introduce more clotting properties to their blood process.

                This is what I understand about it. I asked my mom's cardiologist
                about it, and he said to not change what she's on now (which is 30mg
                of CoQ10 3 times a day), but just don't increase it or stop it
                completely. Stopping it completely will throw off the clotting
                properties of the drug and whatever else is helping her blood clot.
                Like he said don't increase your vitamin E, because that thins the
                blood too, so do garlic, gingko, ginger, cayenne, which are all
                supplements that my mom takes.

                I'm hoping someone else who is more knowledgeable about all this
                will speak up. I know there are a few members who lurk a lot, who
                are very knowledgeable about the chemistry of the interaction of
                things.

                From the literature that I've read about CoQ10, if you've been on it
                for a while, you should not stop it cold, because the benefits of
                taking CoQ10, which include strengthening the heart muscle tissue,
                can be a shock to the muscle when it's not getting that influx of
                CoQ10 anymore. I don't have any offical information about that,
                but just what other people have told me they found out and some
                people who wrote to me last summer, when I had to take Snowball off
                of it (she was on it for two years). We took her off of all her
                supplements after she had a seizure in June, all except for her
                CoQ10, and later I weaned her off of that a couple of months later,
                because we don't know what, if anything, of her supplements is
                making her throw up all the time. I don't like that she's not
                taking it anymore, because she has serious heart issues (HCM, grade
                4 murmur, mitral valve regurgitation). But everytime I give it to
                her she throws up, so it just doesn't agree with her tummy anymore I
                guess.

                Anyway, if it was me, I wouldn't stop Sangie's CoQ10. From what I
                can find out, the little clotting properties that the CoQ10 may
                have, would be what's normal for her since she's been on it for so
                many years prior to her heparin.

                hugs,
                Carol and Snowball and the gang
              • tabbyandpeachy
                Just was wondering if there was anymore thoughts on COQ 10 and blood thinners? should we continues to give? or should all of us who s babies are on it, should
                Message 7 of 14 , Feb 3, 2009
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                  Just was wondering if there was anymore thoughts on COQ 10 and blood
                  thinners? should we continues to give? or should all of us who's
                  babies are on it, should start to whean them off of it?
                  Thanks a bunch for all the info -Patty


                  --- In feline-heart@yahoogroups.com, "Carol" <carolroars@...> wrote:
                  >
                  > Hi Kathy,
                  >
                  > I wouldn't stop the CoQ10 if Sangie has been on it for that many
                  > years. Since her system is used to whatever the effects are of the
                  > CoQ10, her blood would be "normal" for her prior to the heparin
                  > treatment. I mean, her blood clotting factors are the "normal"
                  that
                  > they are "with" her taking CoQ10, way prior to her ever getting
                  > heparin. So her heparin dose and frequency was given to her with
                  her
                  > body "used to" whatever the CoQ10 may contribute as far as clotting
                  > factors. It's like someone whe eats a lot of veggies with vitamin
                  K
                  > in them, things like green leafy veggies and cruciferous (broccoli,
                  > etc.). If they've always eaten those things and then have to be
                  put
                  > on blood thinners, the thinners are based on what their bodies are
                  > currently getting. But if they're not used to having those things,
                  > they shouldn't "start" eating veggies with vitamin K, because that
                  > would introduce more clotting properties to their blood process.
                  >
                  > This is what I understand about it. I asked my mom's cardiologist
                  > about it, and he said to not change what she's on now (which is
                  30mg
                  > of CoQ10 3 times a day), but just don't increase it or stop it
                  > completely. Stopping it completely will throw off the clotting
                  > properties of the drug and whatever else is helping her blood
                  clot.
                  > Like he said don't increase your vitamin E, because that thins the
                  > blood too, so do garlic, gingko, ginger, cayenne, which are all
                  > supplements that my mom takes.
                  >
                  > I'm hoping someone else who is more knowledgeable about all this
                  > will speak up. I know there are a few members who lurk a lot, who
                  > are very knowledgeable about the chemistry of the interaction of
                  > things.
                  >
                  > From the literature that I've read about CoQ10, if you've been on
                  it
                  > for a while, you should not stop it cold, because the benefits of
                  > taking CoQ10, which include strengthening the heart muscle tissue,
                  > can be a shock to the muscle when it's not getting that influx of
                  > CoQ10 anymore. I don't have any offical information about that,
                  > but just what other people have told me they found out and some
                  > people who wrote to me last summer, when I had to take Snowball off
                  > of it (she was on it for two years). We took her off of all her
                  > supplements after she had a seizure in June, all except for her
                  > CoQ10, and later I weaned her off of that a couple of months later,
                  > because we don't know what, if anything, of her supplements is
                  > making her throw up all the time. I don't like that she's not
                  > taking it anymore, because she has serious heart issues (HCM, grade
                  > 4 murmur, mitral valve regurgitation). But everytime I give it to
                  > her she throws up, so it just doesn't agree with her tummy anymore
                  I
                  > guess.
                  >
                  > Anyway, if it was me, I wouldn't stop Sangie's CoQ10. From what I
                  > can find out, the little clotting properties that the CoQ10 may
                  > have, would be what's normal for her since she's been on it for so
                  > many years prior to her heparin.
                  >
                  > hugs,
                  > Carol and Snowball and the gang
                  >
                • Judi Levens
                  I too am unsure of what to do, Max seems to be doing wonderfully right now, and I don t want to change anything! I also wanted to know, is it the lasix which
                  Message 8 of 14 , Feb 4, 2009
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                    I too am unsure of what to do, Max seems to be doing wonderfully right now, and I don't want to change anything!
                    I also wanted to know, is it the lasix which causes the kidney problems, or just any meds, or is it the enalapril? I think it's the lasix, and since Max doesn't seem to be having any problems I was thinking of reducing his dosage...any comments?
                    thanks...Judi and Max



                    To: feline-heart@yahoogroups.comFrom: oceanbreeze1@...: Wed, 4 Feb 2009 05:52:21 +0000Subject: Re: [FH] IMPORTANT INFO: Taking CoQ10 with blood thinners



                    Just was wondering if there was anymore thoughts on COQ 10 and blood thinners? should we continues to give? or should all of us who's babies are on it, should start to whean them off of it?Thanks a bunch for all the info -Patty--- In feline-heart@yahoogroups.com, "Carol" <carolroars@...> wrote:>> Hi Kathy,> > I wouldn't stop the CoQ10 if Sangie has been on it for that many > years. Since her system is used to whatever the effects are of the > CoQ10, her blood would be "normal" for her prior to the heparin > treatment. I mean, her blood clotting factors are the "normal" that > they are "with" her taking CoQ10, way prior to her ever getting > heparin. So her heparin dose and frequency was given to her with her > body "used to" whatever the CoQ10 may contribute as far as clotting > factors. It's like someone whe eats a lot of veggies with vitamin K > in them, things like green leafy veggies and cruciferous (broccoli, > etc.). If they've always eaten those things and then have to be put > on blood thinners, the thinners are based on what their bodies are > currently getting. But if they're not used to having those things, > they shouldn't "start" eating veggies with vitamin K, because that > would introduce more clotting properties to their blood process. > > This is what I understand about it. I asked my mom's cardiologist > about it, and he said to not change what she's on now (which is 30mg > of CoQ10 3 times a day), but just don't increase it or stop it > completely. Stopping it completely will throw off the clotting > properties of the drug and whatever else is helping her blood clot. > Like he said don't increase your vitamin E, because that thins the > blood too, so do garlic, gingko, ginger, cayenne, which are all > supplements that my mom takes.> > I'm hoping someone else who is more knowledgeable about all this > will speak up. I know there are a few members who lurk a lot, who > are very knowledgeable about the chemistry of the interaction of > things.> > From the literature that I've read about CoQ10, if you've been on it > for a while, you should not stop it cold, because the benefits of > taking CoQ10, which include strengthening the heart muscle tissue, > can be a shock to the muscle when it's not getting that influx of > CoQ10 anymore. I don't have any offical information about that, > but just what other people have told me they found out and some > people who wrote to me last summer, when I had to take Snowball off > of it (she was on it for two years). We took her off of all her > supplements after she had a seizure in June, all except for her > CoQ10, and later I weaned her off of that a couple of months later, > because we don't know what, if anything, of her supplements is > making her throw up all the time. I don't like that she's not > taking it anymore, because she has serious heart issues (HCM, grade > 4 murmur, mitral valve regurgitation). But everytime I give it to > her she throws up, so it just doesn't agree with her tummy anymore I > guess.> > Anyway, if it was me, I wouldn't stop Sangie's CoQ10. From what I > can find out, the little clotting properties that the CoQ10 may > have, would be what's normal for her since she's been on it for so > many years prior to her heparin.> > hugs,> Carol and Snowball and the gang>






                    [Non-text portions of this message have been removed]
                  • Kathy Wood
                    Sangie has been on enalapril for many years & has had no problems w/kidneys. The cardiologist said it actually can have a protective effect on the kidneys
                    Message 9 of 14 , Feb 4, 2009
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                      Sangie has been on enalapril for many years & has had no problems
                      w/kidneys. The cardiologist said it actually can have a protective
                      effect on the kidneys w/many cats. The lasix, which Sangie has been on
                      for about 1 year, is what they watch carefully w/her kidneys. Once she
                      was out of heart failure, we reduced the lasix dose & she seems to be
                      doing fine.
                      Best of luck to you & Max.
                      Kathy & Sangie-

                      Judi Levens wrote:

                      >
                      > I too am unsure of what to do, Max seems to be doing wonderfully right
                      > now, and I don't want to change anything!
                      > I also wanted to know, is it the lasix which causes the kidney
                      > problems, or just any meds, or is it the enalapril? I think it's the
                      > lasix, and since Max doesn't seem to be having any problems I was
                      > thinking of reducing his dosage...any comments?
                      > thanks...Judi and Max
                      >
                      > To: feline-heart@yahoogroups.comFrom
                      > <mailto:feline-heart%40yahoogroups.comFrom>:
                      > oceanbreeze1@... <mailto:oceanbreeze1%40gmail.comDate>: Wed,
                      > 4 Feb 2009 05:52:21 +0000Subject: Re: [FH] IMPORTANT INFO: Taking
                      > CoQ10 with blood thinners
                      >
                      > Just was wondering if there was anymore thoughts on COQ 10 and blood
                      > thinners? should we continues to give? or should all of us who's
                      > babies are on it, should start to whean them off of it?Thanks a bunch
                      > for all the info -Patty--- In feline-heart@yahoogroups.com
                      > <mailto:feline-heart%40yahoogroups.com>, "Carol" <carolroars@...>
                      > wrote:>> Hi Kathy,> > I wouldn't stop the CoQ10 if Sangie has been on
                      > it for that many > years. Since her system is used to whatever the
                      > effects are of the > CoQ10, her blood would be "normal" for her prior
                      > to the heparin > treatment. I mean, her blood clotting factors are the
                      > "normal" that > they are "with" her taking CoQ10, way prior to her
                      > ever getting > heparin. So her heparin dose and frequency was given to
                      > her with her > body "used to" whatever the CoQ10 may contribute as far
                      > as clotting > factors. It's like someone whe eats a lot of veggies
                      > with vitamin K > in them, things like green leafy veggies and
                      > cruciferous (broccoli, > etc.). If they've always eaten those things
                      > and then have to be put > on blood thinners, the thinners are based on
                      > what their bodies are > currently getting. But if they're not used to
                      > having those things, > they shouldn't "start" eating veggies with
                      > vitamin K, because that > would introduce more clotting properties to
                      > their blood process. > > This is what I understand about it. I asked
                      > my mom's cardiologist > about it, and he said to not change what she's
                      > on now (which is 30mg > of CoQ10 3 times a day), but just don't
                      > increase it or stop it > completely. Stopping it completely will throw
                      > off the clotting > properties of the drug and whatever else is helping
                      > her blood clot. > Like he said don't increase your vitamin E, because
                      > that thins the > blood too, so do garlic, gingko, ginger, cayenne,
                      > which are all > supplements that my mom takes.> > I'm hoping someone
                      > else who is more kn! owledgea ble about all this > will speak up. I
                      > know there are a few members who lurk a lot, who > are very
                      > knowledgeable about the chemistry of the interaction of > things.> >
                      > From the literature that I've read about CoQ10, if you've been on it >
                      > for a while, you should not stop it cold, because the benefits of >
                      > taking CoQ10, which include strengthening the heart muscle tissue, >
                      > can be a shock to the muscle when it's not getting that influx of >
                      > CoQ10 anymore. I don't have any offical information about that, > but
                      > just what other people have told me they found out and some > people
                      > who wrote to me last summer, when I had to take Snowball off > of it
                      > (she was on it for two years). We took her off of all her >
                      > supplements after she had a seizure in June, all except for her >
                      > CoQ10, and later I weaned her off of that a couple of months later, >
                      > because we don't know what, if anything, of her supplements is >
                      > making her throw up all the time. I don't like that she's not > taking
                      > it anymore, because she has serious heart issues (HCM, grade > 4
                      > murmur, mitral valve regurgitation). But everytime I give it to > her
                      > she throws up, so it just doesn't agree with her tummy anymore I >
                      > guess.> > Anyway, if it was me, I wouldn't stop Sangie's CoQ10. From
                      > what I > can find out, the little clotting properties that the CoQ10
                      > may > have, would be what's normal for her since she's been on it for
                      > so > many years prior to her heparin.> > hugs,> Carol and Snowball and
                      > the gang>
                      >
                      > [Non-text portions of this message have been removed]
                      >
                      >


                      --
                      Kathy Wood
                      Executive Program Manager
                      UNC-Chapel Hill AGEP
                      Department of Chemistry
                      Kenan Labs, CB#3290
                      p) 919.962.2509
                      f) 919.843.2554
                      kathy_wood@...

                      www.unc.edu/agep
                      www.acsbe.org
                      www.unc.edu/opt-ed
                    • moonpye
                      I m not going to change anything right now. Skylar is doing well too, but I am concerned about the Plavix with the Coq10. His cardio knows he is taking the
                      Message 10 of 14 , Feb 4, 2009
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                        I'm not going to change anything right now. Skylar is doing well too, but I
                        am concerned about the Plavix with the Coq10. His cardio knows he is taking
                        the Coq10 and didn't say that he shouldn't. I had him on a lower dose and
                        the cardio said 30mg is what he should be on.
                        I will have to ask him next visit if he should continue with it and about
                        the Plavix. If anyone finds out more info please let us know.


                        Judi, after starting Enalapril, the cardio said Skylar must have a renal
                        panel to see how his kidneys were...we have not had to start the Lasix, I am
                        sure you would watch the kidneys with it too...I would check with the cardio
                        about reducing Max's Lasix.


                        Candace with Cinnamon and Skylar :)






                        >
                        > I too am unsure of what to do, Max seems to be doing wonderfully right now,
                        > and I don't want to change anything!
                        > I also wanted to know, is it the lasix which causes the kidney problems, or
                        > just any meds, or is it the enalapril? I think it's the lasix, and since
                        > Max doesn't seem to be having any problems I was thinking of reducing his
                        > dosage...any comments?
                        > thanks...Judi and Max




                        >
                        >
                        >
                        > Just was wondering if there was anymore thoughts on COQ 10 and blood
                        > thinners? should we continues to give? or should all of us who's babies are
                        > on it, should start to whean them off of it?Thanks a bunch for all the info
                        > -Patty
                        >


                        [Non-text portions of this message have been removed]
                      • Pat
                        Hi All; ... From: Carol ... As we have recently had to deal with this sort of thing I agree with Carol on principle as heparin was
                        Message 11 of 14 , Feb 4, 2009
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                          Hi All;

                          ----- Original Message -----
                          From: "Carol" <carolroars@...>
                          > I wouldn't stop the CoQ10 if Sangie has been on it for that many
                          > years. Since her system is used to whatever the effects are of the
                          > CoQ10, her blood would be "normal" for her prior to the heparin
                          > treatment.

                          As we have recently had to deal with this sort of thing I agree with Carol
                          on principle as heparin was one drug DH didn't have to modify diet to use.
                          Having said that, if anyone wants all the abstracts to do with a supplement,
                          there is a search database where you can enter CoQ10 and search the
                          responses for relevent information:
                          http://grande.nal.usda.gov/ibids/index.php

                          Be warned that when I put in CoQ10 as the search criteria I came up with
                          1373 records, but I think they go by date so most relevent would be the
                          newest ones on the topic.

                          Pat and all the boys.
                          http://felinenutritionalnotes.blogspot.com/
                          http://petfoodpitfalls.blogspot.com/
                        • dshale1
                          Our cardiologist said both the enalapril and the lasix can be hard on the kidneys, so he wanted Pye s kidney function tested after two weeks of starting the
                          Message 12 of 14 , Feb 5, 2009
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                            Our cardiologist said both the enalapril and the lasix can be hard on
                            the kidneys, so he wanted Pye's kidney function tested after two weeks
                            of starting the drugs and then after a month, and every three months
                            thereafter. So far her test have all been normal, but she only started
                            on the enalapril and fuoremide in Nov.

                            Our vet said if there is a problem it would likely show up right away,
                            but I wonder if taking these drugs long-terms also strains the kidneys.
                            -Susan


                            --- In feline-heart@yahoogroups.com, Judi Levens <casaobelisco@...> wrote:
                            >
                            >
                            > I too am unsure of what to do, Max seems to be doing wonderfully
                            right now, and I don't want to change anything!
                            > I also wanted to know, is it the lasix which causes the kidney
                            problems, or just any meds, or is it the enalapril? I think it's the
                            lasix, and since Max doesn't seem to be having any problems I was
                            thinking of reducing his dosage...any comments?
                            > thanks...Judi and Max
                            >
                            >
                          • Imbali (Bettina Schmolla)
                            Hi Susan and Carol, sorry, I had intended to investigate in this topic much earlier, but then ... ;-) - Nevertheless, it was only postponed, not forgotten! :-)
                            Message 13 of 14 , Mar 30, 2009
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                              Hi Susan and Carol,

                              sorry, I had intended to investigate in this topic much earlier, but then ... ;-) - Nevertheless, it was only postponed, not forgotten! :-)

                              First I want to say, I am not an expert, "only" a very interested lay person with two heart kitties who might need "blood thinners" (I dislike this expression, as these drugs don't really thin the blood, they simply prevent the forming of clots in it) one day as well ...

                              I did not check the resemblence of CoQ10 and Vitamin K, I "simply believe you" here. ;-) But to me it was especially interesting if Vitamin K (or anything that is structurally related) is really a kind of antidot to *any* kind of "blood thinner" or only to coumarin drugs.

                              I like starting my research in Wikipedia, I must confess, and here it looks like Vitamin K is only relevant for treatments with coumarin drugs:

                              http://en.wikipedia.org/wiki/Vitamin_k
                              Vitamin K is involved in the carboxylation of certain glutamate residues in proteins to form gamma-carboxyglutamate residues (abbreviated Gla-residues).
                              [...]
                              At this time 14 human proteins with Gla domains have been discovered, and they play key roles in the regulation of three physiological processes:
                              * Blood coagulation: (prothrombin (factor II), factors VII, IX, X,
                              protein C, protein S and protein Z).
                              [...]
                              Warfarin and other coumarin drugs block the action of the Vitamin K epoxide reductase. This results in decreased concentrations of Vitamin K and Vitamin K hydroquinone in the tissues, such that the carboxylation reaction catalyzed by the glutamyl carboxylase is inefficient. This results in the production of clotting factors with inadequate Gla. Without Gla on the amino termini of these factors, they no longer bind stably to the blood vessel endothelium and cannot activate clotting to allow formation of a clot during tissue injury.

                              http://en.wikipedia.org/wiki/Warfarin
                              Warfarin inhibits the vitamin K-dependent synthesis of biologically active forms of the calcium-dependent clotting factors II, VII, IX and X, as well as the regulatory factors protein C, protein S, and protein Z.
                              [...]
                              The precursors of these factors require carboxylation of their glutamic acid residues to allow the coagulation factors to bind to phospholipid surfaces inside blood vessels, on the vascular endothelium. The enzyme that carries out the carboxylation of glutamic acid is gamma-glutamyl carboxylase. The carboxylation reaction will proceed only if the carboxylase enzyme is able to convert a reduced form of vitamin K (vitamin K hydroquinone) to vitamin K epoxide at the same time. The vitamin K epoxide is in turn recycled back to vitamin K and vitamin K hydroquinone by another enzyme, the vitamin K epoxide reductase (VKOR). Warfarin inhibits epoxide reductase[7] (specifically the VKORC1 subunit[23][24]), thereby diminishing available vitamin K and vitamin K hydroquinone in the tissues, which inhibits the carboxylation activity of the glutamyl carboxylase. When this occurs, the coagulation factors are no longer carboxylated at certain glutamic acid residues, and are incapable of binding to the endothelial surface of blood vessels, and are thus biologically inactive.
                              (Wow, I had to re-read this several times to get the feeling that I understand it!)
                              As the body's stores of previously-produced active factors degrade (over several days) and are replaced by inactive factors, the anticoagulation effect becomes apparent. The coagulation factors are produced, but have decreased functionality due to undercarboxylation; they are collectively referred to as PIVKAs (proteins induced [by] vitamin K absence/antagonism), and individual coagulation factors as PIVKA-number (e.g. PIVKA-II). The end result of warfarin use, therefore, is to diminish blood clotting in the patient.
                              [...]
                              The effects of warfarin can be reversed with vitamin K, or, when rapid reversal is needed (such as in case of severe bleeding), with prothrombin complex concentrate—which contains only the factors inhibited by warfarin—or fresh frozen plasma (depending upon the clinical indication) in addition to intravenous vitamin K.

                              If I read this I find it even hard to understand how exactly CoQ10 can interfere with coumarin. I find it hard to believe that CoQ10 can be so near to Vitamin K that it can take over the work of Vitamin K in this process of building the correct active forms of the clotting factors. But I think, if it says everywhere that CoQ10 can be a problem because its structure is so near to Vitamin K, then this must be the case, or? But then I would even say: If you are giving your cat CoQ10 and Warfarin now, do NOT reduce the CoQ10 without reducing the Warfarin as well, because otherwise I would fear bleeding, for the balance between Warfarin and Warfarin antidots would not be there anymore and you would perhaps be giving your cat too much Warfarin ... But the same is of course relevant for Vitamin K in the cat food, I think. it might be a good idea to watch your cat carefully if you change the food, for the new food may contain much more or less vitamin K ... :-(

                              > I am interested in this warning as well. Our cat is on Plavix, which
                              > is somewhat more forgiving than warfarin or heparin, but it does say
                              > in the warnings that CoQ10 may affect Plavix' effectiveness.

                              And now this is something that I don't understand: After reading the explanation of vitamin K and Warfarin in Wikipedia (by the way I researched it in German first, much easier for me ;-) and then looked it up in English as well), I don't really understand how CoQ10 could interfere at all with a drug that does not work like a coumarin, inhititing the synthesis of biologically active forms of some calcium-dependent clotting factors.

                              http://en.wikipedia.org/wiki/Plavix
                              Clopidogrel is a pro-drug whose action may be related to adenosine diphosphate (ADP) receptor on platelet cell membranes. The specific subtype of ADP receptor that clopidogrel irreversibly inhibits is P2Y12 and is important in platelet aggregation and the cross-linking of platelets by fibrin. The blockade of this receptor inhibits platelet aggregation by blocking activation of the glycoprotein IIb/IIIa pathway. The IIb/IIIa complex functions as a receptor mainly for fibrinogen and vitronectin but also for fibronectin and von Willebrand factor. Activation of this receptor complex is the "final common pathway" for platelet aggregation, and is important in platelet aggregation, the cross-linking of platelets by fibrin.

                              To me this looks like a mechanism very different from the one in coumarins. So how can CoQ10 interfere with this drug? I reas it but have difficulties understanding how ...

                              > I have decided to gradually reduce the amount of CoQ10 we have been
                              > giving--

                              Hmmmmm, *if* CoQ10 really interferes with plavix and your cat is on its personal, optimal dose of Plavix now, then I would probably rather not dare change anything ... (Sorry, I know that these thoughts of mine are very late now ...)


                              By the way, now I was curious and looked up Aspirin as well:
                              http://en.wikipedia.org/wiki/Aspirin
                              Aspirin's ability to suppress the production of prostaglandins and thromboxanes is due to its irreversible inactivation of the cyclooxygenase (COX) enzyme. Cyclooxygenase is required for prostaglandin and thromboxane synthesis. Aspirin acts as an acetylating agent where an acetyl group is covalently attached to a serine residue in the active site of the COX enzyme.
                              [...]
                              Low-dose, long-term aspirin use irreversibly blocks the formation of thromboxane A2 in platelets, producing an inhibitory effect on platelet aggregation.

                              Does anyone understand, how CoQ10 could interfere in this process ???


                              I haven't tried now to find out anything about Nattokinase, I remember my last research where I wasn't really able to find out how *exactly* Nattokinase prevents clotting. And if I don't know that, I can't know which other drugs / supplements could interfere with the anti-clotting effect of Nattokinase either ... :-(


                              Hm, as I said in the beginning, I'm not an expert, so there might be wrong conclusions in my mail here ... But to me it looks very much like CoQ10 can hardly interfere with other drugs than coumarin. And I would not reduce CoQ10 in the therapy of a cat getting Warfarin without reducing Warfarin as well or at least watching my cat very, very carefully afterwards ...


                              Sorry, this has become very long now ... Typically me ... ;-)

                              Greetings
                              Bettina with 2 1/2 heart kitties
                              and more of them without heart problems
                              http://www.pristine-paws.de
                            • Carol
                              hi Bettina, Thank you so much for doing all this research. I have to admit, I don t understand most of it though. What I m gathering is that the interaction
                              Message 14 of 14 , Mar 31, 2009
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                                hi Bettina,

                                Thank you so much for doing all this research. I have to admit, I don't understand most of it though. What I'm gathering is that the interaction of CoQ10 having vitamin K properties may only be with Coumadin/Warfarin. I've searched and searched so much about this because my mom takes the Coumadin and my cats take CoQ10 and I just don't know for sure what the answers are to this.

                                I agree with you about changing food and/or supplements and meds, to always do it very slowly and with the guidance of the vet. Blood thinning and clotting isn't something you want to mess around with.

                                What I've done with my mom and the cats is, since they were ALREADY taking CoQ10 and have for years, then were introduced to the blood thinners, I figure that what the docs based their blood thinner dose on was already taking into consideration the CoQ10 in their system, since all the blood tests were done while they were already on CoQ10.

                                What I probably wouldn't do, without doing it slowly and under the direct supervision from a qualified cardiologist, is add CoQ10 to a cat that already has been on blood thinners for a long time.

                                Now beginning CoQ10 simultaneously with blood thinners...that I'm not sure about either.

                                I'd really like to find out for sure if this Vitamin K thing with the CoQ10 only applies to Coumadin/Warfarin, or if it applies to all blood thinners.

                                I think that the Vitamin K activity, however much there is, in CoQ10 can't be that much that it would interfere with the blood thinners we give our cats, especially the doses we give. We don't give mega doses of CoQ10, in my opinion, to make any difference.

                                But then again, I just don't know for sure.

                                This is going to be an ongoing subject I think. I really appreciate the research you did Bettina. I know how long that must have taken. I'm going to put the info as a file in our "Files" section for everyone to access easily.

                                hugs,
                                Carol and Snowball and the gang
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