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CBD oil and Sintrom: Does CBD affect coagulation?

CBD hypertension

El aceite de CBD ha conquistado el mundo del bienestar, pero ¿es adecuado para todo el mundo? ¿Tiene contraindicaciones? Estas son algunas dudas que pueden acechar a los usuarios. Hoy abordamos si el CBD combina bien con los medicamentos anticoagulantes, en particular, con el Sintrom (acenocumarol) y la Warfarina. ¿Puede el CBD afectar a la coagulación y al efecto de estos medicamentos? Vamos a responder estas preguntas, con base a lo conocido, según la investigación científica actual.

Note: This is an informational article that is not intended to prevent, diagnose or treat any disease. Its content can complement, but never replace, the diagnosis or treatment of any disease or symptom. Cannactiva products are not medicines and are intended for external use. Consult your doctor before using CBD.

Can CBD affect clotting?

Sí, el cannabidiol o CBD puede influir en la coagulación. Según estudios preclínicos, el cannabidiol afecta la agregación plaquetaria. Aunque no se ha demostrado que sus efectos tengan contraindicaciones cuando se utiliza solo o en personas sanas, se debe tener precaución al tomar CBD vía oral en caso de enfermedad, o si se están tomando otros medicamentos.

How does CBD affect anticoagulants?

CBD has the potential to increase blood levels of certain medications, such as anticoagulants, by inhibiting the liver enzymes that metabolize these drugs. This could potentiate its effects and increase the risk of bleeding.

Can I take CBD if I am taking Sintrom?

Mixing CBD and anticoagulants could potentiate the effect of anticoagulants such as Sintrom, increasing the risk of bleeding. Therefore, this point should be assessed by the medical practitioner. Doses of Sintrom or CBD may need to be adjusted.

Can I take CBD if I am taking Warfarin?

In some clinical cases, complications have been observed with the concomitant use of cannabis products and anticoagulants such as Warfarin. It is recommended that, if simultaneous use is necessary, it should be carried out under strict medical supervision.

Are there any known contraindications between CBD and anticoagulants?

Si, hay casos clínicos reportados donde el uso concomitante de CBD y anticoagulantes disminuye el tiempo de coagulación por debajo del margen terapéutico. Esto es observado con otros cannabinoides también, por lo tanto, se deben tomar precauciones en el uso terapéutico de cannabis medicinal y medicamentos anticoagulantes.

Is CBD safe to use?

Yes. CBD has a wide range of potential benefits, but it is not without its complexities, especially when combined with certain medications. We tell you more about it below.

CBD oil and anticoagulant drugs

What are anticoagulants?

Anticoagulants are drugs that “thin” blood, i.e., they are drugs that prevent blood from clotting too quickly, ensuring a smooth flow through our veins and arteries.

They are administered to prevent thrombi and serious complications, such as heart attacks or strokes. However, its action requires careful monitoring to avoid bleeding.

How do anticoagulants work and how are they metabolized?

Anticoagulants are metabolized in the liver and act by targeting specific blood proteins involved in coagulation processes.

Sintrom, whose active ingredient is acenocoumarol, is a widely used anticoagulant that acts as a vitamin K antagonist. It is a key element in the coagulation cascade.

Like Sintrom, Warfarin is also an anticoagulant which interferes with vitamin K.

There are other anticoagulants on the market that are independent of this vitamin, some of them are heparin, enoxaparin (Lovenox), dabigatran (Pradaxa) and rivaroxaban (Xarelto).

CBD and its influence on the effect of anticoagulant drugs

CBD is metabolized in the liver and may influence the function of certain liver enzymes. This is crucial because these same enzymes also metabolize many other drugs, including anticoagulants.

When CBD inhibits these enzymes in the liver, it can lead to increased levels of other drugs in the bloodstream. This is of concern with drugs that have a narrow therapeutic index, where too much or too little can be problematic.

Anticoagulant drugs and CBD oil: possible interactions

Possible effects of CBD on coagulation

Coagulation is the process by which blood forms clots to stop bleeding. It involves a series of chemical reactions leading to the formation of a solid mass (clot) from liquid blood. This process involves vitamin K and occurs through the aggregation of platelets, the formation of fibrin strands, through the help of thrombin, and the activation of other proteins in the blood. Coagulation is crucial for wound healing and prevention of excessive bleeding.

Los cannabinoides han demostrado en estudios preclínicos que pueden influir en la coagulación. El CBD no afecta la actividad de la trombina tanto como el cannabinol (CBN) y el tetrahidrocannabinol (THC). Sin embargo, el CBD puede interrumpir la agregación plaquetaria (1).

Human scientific studies on CBD and coagulation

There are scientific studies that have studied the effects of CBD on coagulation in preclinical models. In them, it has been observed that CBD can interfere with platelet aggregation (1).

There are no studies on the antiplatelet effect of CBD in humans, due to the difficulty of staying within the ethical framework when a person’s risk of bleeding is increased.

There are clinical case reports where the use of CBD and anticoagulants together has been monitored. In these clinical cases, a significant decrease in coagulation has been observed, so the international normalized ratio (INR) of coagulation time should be monitored at the beginning of treatment and during cannabinoid dosing (2).

There are other anecdotal reports suggesting possible interactions of CBD and anticoagulants. But most studies focus on the effects on coagulation of THC, the psychoactive compound in marijuana.

Preliminary data suggest that high doses of THC may affect platelet function, but comprehensive human studies are limited (3).

Risks of consuming CBD with anticoagulant medication

The main concern of using CBD with anticoagulants at the same time is the risk of excessive anticoagulation. If CBD increases the plasma concentration of the anticoagulant, there may be an increased risk of hemorrhagic episodes.

Recommendations for those taking anticoagulants and wishing to consume CBD

Before combining CBD with anticoagulants, it is essential to consult a health professional. It is crucial to monitor people receiving cannabis products and anticoagulants simultaneously with laboratory testing.

It may be necessary to monitor anticoagulation levels, through assessment of the international normalized ratio (INR), when introducing or adjusting CBD. Close monitoring of medication levels and their effects is therefore essential.

Note: This is an informational article that is not intended to prevent, diagnose or treat any disease. Its content can complement, but never replace, the diagnosis or treatment of any disease or symptom. Cannactiva products are not medicines and are intended for external use. Consult your doctor before using CBD.

  1. Khayat, W., & Lehmann, C. (2022). The Endocannabinoid System: A Potential Therapeutic Target for Coagulopathies. Metabolites, 12(6), 541.
  2. Grayson, L., Vines, B., Nichol, K., Szaflarski, J. P., & UAB CBD Program (2017). An interaction between warfarin and cannabidiol, a case report. Epilepsy & behavior case reports, 9, 10-11.
  3. Damkier, P., Lassen, D., Christensen, M. M. H., Madsen, K. G., Hellfritzsch, M., & Pottegård, A. (2019). Interaction between warfarin and cannabis. Basic & clinical pharmacology & toxicology, 124(1), 28-31.

Masha Burelo
Investigadora en cannabinoides | Doctoranda en Neurociencia

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