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the goal is a stable, healthy diet without large fluctuations in vitamin K intake herbal products and supplements St Johns wort and ginseng can reduce the anticoagulant effect garlic and ginkgo may increase bleeding risk INR should be checked more frequently after major, sustained changes in diet, vitamin K intake, herbal supplements, or interacting medications Dosing and monitoring warfarin is usually started at 2-5 mg once daily, allowing a gradual onset of the effect high loading doses should generally be avoided in sensitive patients because they increase the risk of INR overshoot and early protein C depletion (risk of warfarin-induced skin necrosis) bridging with LMWH/UFH is indication-dependent

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doi: 10.1186/s12951-019-0451-9