A 36-year-old woman with a history of lupus and antiphospholipid syndrome controlled by warfarin presented to the hospital with left periorbital ecchymosis. She was found to have an INR of 9 despite maintaining her normal warfarin dose of 12.5 mg/15 mg alternating qd. The only identifiable precipitating factor was that the patient recently stopped eating dill pickles. Limiting dietary vitamin K while on warfarin therapy was once considered best practice. However, studies have demonstrated that maintaining a consistent intake of vitamin K is more important than the quantity. Still, many patients on warfarin remain unaware of which foods contain large amounts of vitamin K and are, therefore, susceptible to bleeding sequelae. Practitioners should be educated to inform patients to consume a steady amount of vitamin K in their diet, identify which foods contain vitamin K, and include pickles on that list.
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Conflict of interest
Alexa Rangecroft has nothing to disclose. Shamit S. Prabhu has nothing to disclose. Dr. Chi-Cheng Huang reports the following interests outside of the submitted work: stock options with the Scientific Advisory Board for Medicus Tek, a role on the Executive Board for Dynamed Plus—EBSCO with no compensation, and compensated personal fees as a Hospital Medicine Editor for Dynamed Plus—EBSCO.
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Rangecroft, A., Prabhu, S.S. & Huang, CC. Pickles and warfarin interaction: a case-based review. Clin Rheumatol 40, 1621–1624 (2021). https://doi.org/10.1007/s10067-020-05324-9