Is There An Interaction Between Cocoa And Anticoagulants?
In our latest question and answer, the pharmacist discusses the interaction between cocoa and certain anticoagulant medications.
Are there any known interaction between cocoa powder and anticoagulants?
Yes, there is an interaction between cocoa powder and certain anticoagulants. This food-drug interaction can potentially lead to an increased risk of significant bleeding.
The short explanation is that taking cocoa has been shown to inhibit platelet adhesion, aggregation, and activity. This may lead to an increased risk of bleeding in some patients.
Anticoagulant medications are often used to prevent the blood from clotting by also inhibiting platelet activity, adhesion and aggregation, but to a greater degree that often times require close monitoring by your doctor.
Several studies have detailed how cocoa acts as an anticoagulant, such as this one, which compared it to aspirin in regard to its anti-platelet effects.
Below we provide some additional information regarding certain anti-coagulants and cocoa.
Anticoagulants are the primary choice for the prevention and treatment of thrombosis. When making a selection for which anticoagulant to take there are many options to choose from. However, with all anticoagulant medications there is an increased risk of bleeding.
Unfractionated heparin (UFH) is an anticoagulant that is available as a subcutaneous injection or intravenous infusion used to prevent and treat acute coronary syndrome, venous thromboembolism, bridge therapy for atrial fibrillation, and cardioversion. UFH is used for patients that require high doses of heparin or those with a risk of bleeding because UFH leaves the body quickly allowing for a short reversal period if needed.
Low molecular weight heparin (LMWH) is class of medication that are now considered a suitable replacement for UFH. This is because LMWHs are used for the same prevention and treatments as UFH, but LMWH require fewer injections and had fewer adverse events. There is a risk of fatal bleeding when taking LMWH and in such cases protamine is given to reverse the effects of LMWH.
Some patients have an immune-mediated response to heparin called heparin induced thrombocytopenia (HIT) that occurs 4-10 days after taking heparin that causes a life threatening drop of platelets. The incidence of HIT is lower with LMWH when compared to UFH. Patients with HIT should take a direct thrombin inhibitor as the drug of choice.
Direct thrombin Inhibitor (DTI) are the anticoagulant of schoice for patients the treatment of HIT. There is no reversal agent for DTIs. Transition to a DTI should be monitored closely by your doctor as DTIs may lead to misleading lab results.
Vitamin K antagonist (VKA) is an anticoagulant that works by inhbiting vitamin K to be converted to it's active form in the body. This prevent the vitamin K dependent clotting factors from activating. The most common VKA is warfarin.
Warfarin is used for primary and secondary prevention of VTE, primary prevention of stroke, recurrent infarction, or death with acute myocardial infarction, to prevent systemic embolism with prosthetic heart valves or AF, and to prevent acute myocardial infarction in men with a high risk. Major bleeding is a serious risk when taking VKAs. To reverse the effects of a VKA is to stop taking the medication and administer vitamin K. The international normalized ratio (INR) is closely monitored when taking a VKA.
Target Specific Oral Anticoagulants
- Rivaroxaban (Xarelto) is an inhibitor of factor Xa, an important protein that prevents the generation of thrombin and thrombus formation with minimal effects on platelet function. Rivaroxaban is used in the treatment and secondary prevention of DVT or PE, and to prevent stroke in patients with AF. There is no specific laboratory monitoring required making this drug an option for patients. There has been no antidote found, but activated charcoal is recommended for cases of overdose.
- Dabigatran is a DTI that binds reversibly to thrombin, which indirectly causes a decrease of platelet aggregation and activation. Dabigatran is approved for the prevention of stroke in patients with AF. There is no specific laboratory monitoring required making this drug an option for patients.There has been no antidote found, but activated charcoal is recommended for cases of overdose.
- Apixaban is used to prevent stroke and systemic embolism in patients with AF. There is no specific laboratory monitoring required making this drug an option for patients.There has been no antidote found, but activated charcoal is recommended for cases of overdose
The cocoa seed is used as a food used for its known benefits associated with improving patient health for a variety of conditions depending on how the cocoa is taken. The various parts of the seed contains oil, tanins, alkaloids, caffeine,Products derived from cocoa are rich in flavanols, which are associated with decreasing both systolic and diastolic blood pressure and reducing the risk for cardiovascular disease.
Cocoa powder is used to in the prevention of cardiovascular disease and cognitive impairment. The evidence found for the prevention of cardiovascular disease is insufficient, however there was an association between patients that consume higher amounts of cocoa from dietary sources and lower risks of cardiovascular mortality.
The whole cocoa seed is taken orally to prevent and relieve infectious diseases in the intestine, asthma, bronchitis, and lung congestion. Cocoa is very effective for diseases in the gut because the flavanols found in the seed is not changed or absorbed until the small intestine in the gut.
The cocoa seed coat is used for to relieve ailments of the liver, bladder, and kidney; as well as assisting with the management of diabetes.
Cocoa butter is an ointment or lotion commonly used as moisturizer to prevent and reduce the appearance of stretch marks.
Side effects of cocoa include:
- Allergic skin reactions
- Increased urination
- Increased heart rate
- Trigger migraines
- Gastrointestinal discomfort
Avoid taking cocoa products with:
- Anticoagulant/antiplatelet medications, herbs, or supplements- interaction may increase risk of bleeding
- Caffeine containing medication, herbs, or supplements- interaction can increase blood pressure
- Calcium- interaction may increase urinary calcium excretion
- Medication, herbs, and supplements that lower blood pressure-interaction causes an additive decrease in blood pressure
- Iron- interaction inhibits iron absorption
- Magnesium- interaction may increase urinary excretion of magnesium
- Antidiabetic medications- interaction may effect glucose control
Always speak with your doctor before taking any new medications, supplements, vitamins, or making drastic changes to your diet. Many anticoagulant medications have multiple interactions that may effect your treatment. Make sure that these choices are appropriate for your treatment.