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Dietary Considerations

  • Parents should notify physician for:

    • Significant changes in diet with foods high in Vitamin K:

      • Kale, spinach, broccoli, cauliflower, turnip greens, chick peas, brussel sprouts, green tea, soybean oil, liver (beef, pork, or chicken), soy protein products (including tofu), and vitamins A and E in large doses.

      • If the patient's diet already contains these foods, Don't Change Eating Habits. Consistency in the daily eating pattern is key. If any of these foods are routinely consumed, adjust the medication (Warfarin) rather than adjusting the diet.

    • Be aware of Vitamin K when changing from breast feeding to formula:

      • Breast milk averages 4 mcg/L of vitamin K, formula averages 50 mcg/L of vitamin K.

      • Specialized protein hydrolysate formulas may contain higher levels of vitamin K.

  • CMH inpatients will have education on consistency in eating habits. Vitamin K controlled diet will be ordered to ensure consistency of vitamin K content in food while on inpatient status.

  • Patients with vitamin K in TPN before or as warfarin therapy begins:

    • Establish warfarin dosing based on TPN with vitamin K included.

    • Pediatric multi-vitamin product contains vitamin K (200 mcg/5 mL); removing from TPN puts patient at risk for other vitamin deficiencies.

  • Gastrointestinal illness or change in diet can affect INR.


Ansell, J., Hirsh, J., Hylek, E., Jacobson, A., Crowther, M., & Palareti, G. (2008). Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest, 133(6 Suppl), 160s-198s.

Bolton-Maggs, P., & Brook, L. (2002). The use of vitamin K for reversal of over-warfarinization in children. Br J Haematol, 118(3), 924.

David, M., et al. (2004, May). Warfarin Therapy in Children. Thrombosis Interest Group of Canada. Retrieved Oct 21, 2008 from

Horton, J. D., & Bushwick, B. M. (1999). Warfarin therapy: evolving strategies in anticoagulation. Am Fam Physician, 59(3), 635-646.

Lexicomp Online, Pediatric and Neonatal Lexi-Drugs. Kcentra. Retrieved Oct 2008, from 

Lexicomp Online, Pediatric and Neonatal Lexi-Drugs. Warfarin. Retrieved Oct 2008, from

Monagle, P., Chan, A. K. C., Goldenberg, N. A., Ichord, R. N., Journeycake, J. M., Nowak-Göttl, U., & Vesely, S. K. (2012). Antithrombotic therapy in neonates and children: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest, 141(2 Suppl), e737S-e801S.

Monagle, P., Cuello, C. A., Augustine, C., Bonduel, M., Brandão, L. R., Capman, T., Chan, A. K. C., Hanson, S., Male, C., Meerpohl, J., Newall, F., O'Brien, S. H., Raffini, L., van Ommen, H., Wiernikowski, J., Williams, S., Bhatt, M., Riva, J. J., Roldan, Y., . . . Vesely, S. K. (2018). American Society of Hematology 2018 Guidelines for management of venous thromboembolism: treatment of pediatric venous thromboembolism. Blood Adv, 2(22), 3292-3316.

Roach, E. S., Golomb, M. R., Adams, R., Biller, J., Daniels, S., Deveber, G., Ferriero, D., Jones, B. V., Kirkham, F. J., Scott, R. M., & Smith, E. R. (2008). Management of stroke in infants and children: a scientific statement from a Special Writing Group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young. Stroke, 39(9), 2644-2691.

These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.