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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Will Nicotine Be A Cause For Reduction In INR?

my brother just had valve replcement surgeries two months apart to the day, and after 3 months in the hospital started smoking again, his INR dropped to 1.0...in four days, the cardio team want him at 2.0-2.5 because of the new valves, will nicotine cause this to happen
Thu, 27 Aug 2015
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General & Family Physician,  's  Response
Hi & Welcome to HCM.
I appreciate your concern for your beloved brother.

As such there is no documented interaction between Nicotine and Warfarin, but the other chemical compounds that are absorbed into the body from the smoke have an effect on the Warfarin clearance and thus INR.
Smoking has been associated with increased clearance of several drugs including Warfarin.

Thus, your brother may require higher doses of Warfarin to maintain the recommended INR of 2 - 2-5 by the Cardio team or to quit the smoking once for all.

Besides, smoking also activates the clotting pathways & the promotion of thrombosis, which can cause heart attacks.

And Nicotine, the main ingredient in cigarettes as well as in skin patches acts as a stimulant by increasing heart rate and heart contractility. This can further harm a medical condition thereby putting your brother at increased risk for complications on Warfarin therapy.

Hope to have answered your query.

A feedback is appreciated.
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Will Nicotine Be A Cause For Reduction In INR?

Hi & Welcome to HCM. I appreciate your concern for your beloved brother. As such there is no documented interaction between Nicotine and Warfarin, but the other chemical compounds that are absorbed into the body from the smoke have an effect on the Warfarin clearance and thus INR. Smoking has been associated with increased clearance of several drugs including Warfarin. Thus, your brother may require higher doses of Warfarin to maintain the recommended INR of 2 - 2-5 by the Cardio team or to quit the smoking once for all. Besides, smoking also activates the clotting pathways & the promotion of thrombosis, which can cause heart attacks. And Nicotine, the main ingredient in cigarettes as well as in skin patches acts as a stimulant by increasing heart rate and heart contractility. This can further harm a medical condition thereby putting your brother at increased risk for complications on Warfarin therapy. Hope to have answered your query. A feedback is appreciated.