Tiny hearts may have big problems with complementary medicine

    TORONTO, Oct. 27 /CNW Telbec/ - Giving supplement such as herbs,
vitamins, and other natural health products to children taking Warfarin for
congenital heart defects could increase their risk of clots, bleeding, and
other complications, nurse practitioner Mary Bauman and Dr. Patti Massicotte
told the 2008 Canadian Cardiovascular Congress, co-hosted by the Heart and
Stroke Foundation and the Canadian Cardiovascular Society.
    "We just assume these products are safe because they are 'natural' and
don't require a prescription," says Heart and Stroke Foundation-funded
researcher Dr. Massicotte. "The problem is that the anticoagulant action of
Warfarin is unpredictable on its own, so adding dietary supplements to that
can be a challenge. Sometimes that product is the straw that breaks the
camel's back and could push children into high risk situations."
    She says that many marketed supplements can cause changes in the blood
and shouldn't be taken with Warfarin, but there is little research on drug
interactions with these kinds of products. "There is no standardization of the
active ingredient per capsule or tablet between companies and it is this
variation - especially in combination products - that provides the greatest
challenge," she says.
    Some of the most common natural health products taken by the children in
the study included chamomile, lemon, fennel, and green tea. Multivitamins and
minerals were also high on the list, which, Dr. Massicotte warns, can be a
problem if they contain vitamin K - a vitamin that enhances clotting and could
make Warfarin less effective.
    Ms. Bauman, the creator of the Pediatric Outpatient Anticoagulation
Clinic in Edmonton, Alberta has been working with Dr. Massicotte to see how
many children are taking natural health products. They looked at
67 questionnaires which surveyed children taking Warfarin.
    Warfarin is an anticoagulant - also often called a blood thinner - that
helps prevent blood clots from forming in the body. Blood thinners help reduce
risk for heart attack, stroke, and blockages in the arteries and veins.
    They found that 37 per cent of children with heart problems were taking
some kind of dietary supplement and 22 per cent of their parents and
10 per cent of their healthy siblings were taking them as well. Yet, few
parents informed their doctors about their children's use of natural health
products - which can be dangerous for the child since an interaction could
occur with their medication.
    "It is interesting that only 10 per cent of siblings were taking these
products," says Ms. Bauman. "Parents more commonly gave these products to
their child with health challenges believing that these products are safe and
may provide benefit. However, the opposite may be true as supplements have the
potential to negatively influence prescriptive medical care."
    The researchers say the main problem is that the children take these
supplements inconsistently. That means their blood may be thicker on some days
and thinner on others. This can make it difficult for doctors to prescribe the
right amount of Warfarin to protect them from clotting, but not expose them to
bleeding, Dr. Massicotte says.
    "I think that the really important thing is for healthcare professionals
to ask families whether or not they are taking natural health products and for
what purposes," Ms. Bauman says. "And we need to do it in an open and
non-judgemental way because people won't listen to you if you are going
against their beliefs system. That may mean incorporating natural health
products into the treatment and trying to do it the safest way possible."

    Statements and conclusions of study authors are solely those of the study
authors and do not necessarily reflect Foundation or CCS policy or position.
The Heart and Stroke Foundation of Canada and the Canadian Cardiovascular
Society make no representation or warranty as to their accuracy or

    The Heart and Stroke Foundation (heartandstroke.ca), a volunteer-based
health charity, leads in eliminating heart disease and stroke and reducing
their impact through the advancement of research and its application, the
promotion of healthy living, and advocacy.

For further information:

For further information: and/or interviews: CCC 2008 media office, (416)
585-3703 (Oct 26-29); Diane Hargrave, Public Relations, (416) 467-9954,
dhprbks@interlog.com; Congress information and media registration is at
www.cardiocongress.org; After October 29, 2008: Jane-Diane Fraser, Heart and
Stroke Foundation of Canada, (613) 569-4361 ext 273, jfraser@hsf.ca

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