Can vitamin E be used in place of Coumadin?  If so, how much more than
the safe 1000mg.  (IU).  This would be in a case of possible stroke
and a patient being on coumadin as a preventative.

Hi djean,

I have researched your question but would like to remind you to read
the "Important Disclaimer" at the bottom of this page: "Answers and
comments provided on Google Answers are general information, and are
not intended to substitute for informed professional
medical...advice". For patients taking blood-thinning drugs, such as
Coumadin, it is important to talk to your doctor before taking any
amount of vitamin E.

There aren't many physicians ready to recommend completely
substituting Coumadin with vitamin E, but a safer alternative may be
to consider a combination therapy by gradually decreasing the dose of
the Coumadin while increasing the intake of vitamin E to a level
determined by the outcome of Protime tests (a test done to check the
status of your oral anticoagulation therapy) and your doctor. Remember
to take into account the differences in the equivalent IU amounts
between natural and synthetic vitamin E (see below) before deciding on
a dosage. Vitamin E is not without its own health risks and although
it's true that it most likely decreases the chance of suffering a
stroke caused by loss of blood flow to the brain, it may increase the
risk that comes from bleeding in the brain.

1) AlwaysYourChoice: Vitamin E:
"Vitamin E is one of the most famous fat-soluble vitamins. It has
recently been proven to lower the incidence of heart attacks and
strokes by decreasing the clumping of platelets that block arteries
that carry blood throughout the body."
"Caution: Vitamin E is a blood thinner, therefore, caution is in order
if you are taking other over the counter blood thinners such as
aspirin, gingko biloba, ginger, garlic, omega three fatty acids or
prescription blood thinners like Coumadin. We also recommend that you
take no more than the DV of 30IUs if you have problems with blood
coagulation, thrombocytopenia, diabetes or rheumatic heart disease. If
you have high blood pressure, ask your doctor. Vitamin E may increase
risk of stroke."
http://alwaysyourchoice.com/ayc/nutrition/micronutrients/vitamine.php

2) BluePrint for Health: Vitamin E (Alpha Tocopherol):
Therapeutic Dosages:
"The optimal therapeutic dosage of vitamin E has not been established.
Most studies have used between 50 and 800 IU daily, and some have used
even higher doses. This would correspond to about 50 to 800 mg of
synthetic vitamin E (dl-alpha-tocopherol), or 25 to 400 mg of natural
vitamin E (d-alpha- or mixed tocopherols)."
"If you wish to purchase natural vitamin E, look for a label that says
"mixed tocopherols." However, some manufacturers use this term to mean
the synthetic dl-alpha-tocopherol, so you need to read the contents
closely. Natural tocopherols come as d-alpha-, d-gamma-, d-delta-, and
d-beta-tocopherol."
"The adult safe upper intake level (UL) for vitamin E is set at 1,000
mg daily.128 The equivalent amounts are 1,500 IU of natural vitamin E
and 1,100 IU of synthetic vitamin E."
"The results of a study on vitamin E and Coumadin found no evidence of
interaction, but it would still not be advisable to combine these
treatments except under a physician's supervision.132"
http://blueprint.bluecrossmn.com/topic/topic100587895 

One of the references from above:
Leppala JM, Virtamo J, Fogelholm R, et al. Vitamin E and beta carotene
supplementation in high risk for stroke. A subgroup analysis of the
Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. Arch Neurol.
2000;57:1503-1509.
"CONCLUSION: Vitamin E supplementation may prevent ischemic stroke in
high-risk hypertensive patients, but further studies are needed. Arch
Neurol. 2000;57:1503-1509"
http://www.1stvitality.co.uk/az/a/091100_02_carotenes_vit_e_strokes.html

3) DoctorYourself.com: Drug Alternatives:
 "There is a nutritional alternative for most drugs.  You have to dig
a bit for the details, but the work has been done. You will find very
few negative effects from vitamins in the PDR, but you will see column
after column and page after page of side effects, contraindications
and warnings for drugs.  For example, I give you Coumadin.
 You can often use vitamin E instead. Vitamin E potentiates the
effects of Coumadin (Warfarin sodium), and at up to 3,200 IU or less
daily, it can completely and safely substitute for the drug.  That is
just plain true.  I've seen it again and again.
 A cumulative overdose of vitamin E, even extreme megadosing, has
never killed anybody.  Check the US Poison Control Centers data, or
the DAWN statistical series if you don't believe me.  So vitamin E has
a Coumadin-like effect without a Coumadin-like danger.

"Will I get the same results with vitamin E?" he asked.

 "You might," I said.  "E is certainly safer than Coumadin.  Ask you
doctor to try a gradual reduction dosage of the drug while gradually
increasing the vitamin dosage.  I've seen that work well before."
 "I'd prefer the doctor was in on this," I responded, but if you are
going to do it, do it right.  Increase the dose over a period of
weeks.  Most people start with 200 IU daily, and eventually get to
between 1,200 and 2,400 IU daily.  Do it gradually, and here's a way
to tell how you're coming: Go in to your doctor regularly, as you
always do.  Have him check your protime, as he always does.  If you
get the numbers he wants, he won't care how you got them."

"Could I increase the vitamin E and still stay on the Coumadin?" Bob
wondered.

 "More or less, but the more E you taking, the stronger the Coumadin's
effect.  You'll probably get to the point where your protime is too
long, and he'll have to cut back on the dosage of Coumadin."
http://www.doctoryourself.com/drugalt.html

4) Recommended Supplements:
"We can therefore safely conclude that taking Vitamin E up to 400
units per day does not affect the PT time in patients on Coumadin,
generally speaking. But since each person is different, it is always
good to consult your physician.  A word of advise. If you are on blood
thinners and taking vitamin E at the same time, do have your INR
checked 2 weeks after embarking on this combination. Close monitoring
every month, at least for the first 3 months should be carried out if
you are on this combination therapy."
http://www.health-heart.org/vitamins.htm

5) The American Federation of Aging Research: Vitamin E
"In observational studies, vitamin E has been shown to reduce the risk
of fatal and non-fatal heart attacks.22 Researchers are also exploring
its role in stroke prevention. Preliminary studies show that
alpha-tocopherol, a form of vitamin E, decreases strokes that come
from a loss of blood flow to the brain, but increases the risk of
strokes that come from bleeding in the brain."
http://www.healthandage.com/html/min/afar/content/chapter7.htm

6) Vitamin E to reduce the risk of stroke?
"Vitamin E may have a protective effect against ischemic strokes,
researchers reported on April 20 2000 at the annual meeting of the
American Academy of Neurology in Toronto, Canada. Their study showed
that vitamin E supplements can reduce stroke risk by 53%.
Also, researchers from Columbia Presbyterian Medical Center (CPMC) of
New York Presbyterian Hospital found a person's risk of stroke is
reduced by 50% if he or she takes a vitamin E supplement each day.
So there appears to be some protective effect offered by vitamin E,
although it must be said that not all the evidence is conclusive in
this regard."
http://www.healingdaily.com/conditions/stroke-prevention.htm

Additional Links:

Stroke Trials Directory:
http://www.strokecenter.org/trials/browse.asp?browse=prevent

Alternative Therapies
http://www.chfpatients.com/stew/alternative.htm

Forum: Warfarin (Coumadin)
http://www.medhelp.org/HealthTopics/Warfarin.html

Vitamin E:
http://healthlink.mcw.edu/article/983211401.html

Daily Use of Coumadin
http://healthlink.mcw.edu/article/901213830.html

ProTime test:
http://www.protimetest.com/

Vitamin E for sale:
http://www.vitacost.com/Store/products/ProductsList.cfm?scid=3309

I hope this helps and that my answer is what you had in mind when you
posted your question. If you have any questions, please post a
clarification request before rating my answer - it is important to me
that you receive what you need to make an informed decision.

Thank you,
hummer


Google Search Terms Used:

Coumadin vs vitamin e stroke
vitamin e  "stroke prevention"

I am getting this information for my dad.  I will get back to you with
any questions after my mother reviews the information.  So far, looks
good. Thanks

the anticoagulation effect of vitamin E and coumadin are in no way
equivalent. If you have a condition for which coumadin is recommened
(such as atrial fibrillation, artificial heart valve, etc) you would
be taking a huge risk to substitute vitamin E. Huge. Please discuss it
with your doctor; find out exactly what the reasons are that coumadin
is recommended; discuss the risks of not taking it as well as the risk
of taking it. To rely on unscientific anecdotal evidence as quoted in
the above answer is to play russian roulette with your brain.

Thank you for that important advise.  I will pass it on to my mother.
She was wondering if the coumadin affects the memory and if
so will it return when not taking coumadin?

Hi again djean,

Here are two links with info about Coumadin - I couldn't find a link
citing memory loss as one of the side effects of taking Coumadin.

"What are the possible side effects of Coumadin?

Patients on Coumadin need to be aware of several important facts. One
set of facts involves side effects of this drug. The main side effect
is bleeding. Patients who are maintained at a therapeutic level will
not normally bleed spontaneously. Signs and symptoms of bleeding that
need to be discussed with a physician include:

    * a nose bleed that can not be stopped with pressure within ten
minutes
    * gums that bleed even after repeated rinsing with cold water
    * blood in the sputum
    * blood in the urine, which might simply appear as a slight
pinkness of the fluid up to and including bright red blood
    * bleeding in the stomach or intestines, which would show up in
the stool, either as bright red blood or as black tarry substance

Other symptoms which need to be discussed with the physician include:

    * unexplained, sharp and sudden headaches
    * visual changes
    * numbness and tingling in the arms or legs
    * any persistent pain or swelling"
http://www.med.umich.edu/1libr/heart/angina09.htm

How coumadin works and what it is for.
http://www.mediscene.com/patient/topic.php?topic=neuro

Thanks to surgeon-ga for underlining the need to talk your father's
physician - something that is mentioned at least five times in my
answer. I think it's wonderful that your mother is asking questions
and taking an active role in your father's treatment.  I tried to
present a balance for her - hopefully the information will help her
while meeting with the doctor.

Thank you, djean, for the nice rating and note. 
Sincerely,
hummer