Acute ischemic stroke associated with Moringa oleifera and protein powder consumption in a patient on warfarin: A coagulation paradox and clinical blind spot.
- 1Department of Neurosurgery, Southern Tohoku Medical Hospital, Koriyama, Japan.
Abstract
Background
As the global consumption of "superfoods" and fitness supplements surges, active patients on long-term anticoagulation face unprecedented, hidden thrombotic risks.Case description
We report the case of a 30-year-old male with a mechanical aortic valve who presented with an acute left internal carotid artery terminus occlusion. Despite a history of stable warfarin therapy, his international normalized ratio (INR) plummeted after he began mixing Moringa oleifera leaf powder into his daily protein shakes. He underwent emergent mechanical thrombectomy, achieving expanded Thrombolysis in Cerebral Infarction 2C recanalization and dramatic neurological recovery. Upon discontinuation of the supplement, his INR rapidly recovered to 2.6 within a week without altering his original warfarin dose.Conclusion
This case exposes a critical pharmacological paradox: while M. oleifera is widely marketed as a health supplement, it possesses potent intrinsic procoagulant properties and can catastrophically disrupt warfarin efficacy. The concurrent use of protein powder likely enhanced the bioavailability of fat-soluble vitamins, creating a "perfect storm" for rapid coagulation. This evolving dietary trend represents a dangerous clinical blind spot, necessitating proactive dietary screening to prevent life-threatening strokes in anticoagulated patients.
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BibTeX
@article{kobayashi2026acute,
title = {{Acute ischemic stroke associated with Moringa oleifera and protein powder consumption in a patient on warfarin: A coagulation paradox and clinical blind spot.}},
author = {Yuta Kobayashi and Akinori Onuki and Kazuomi Horiuchi and Masahiro Oinuma and Ryoji Munakata and Banri Segawa and Kyohei Saito and Hanaka Ito and Yuta Kazama and Zenichiro Watanabe},
journal = {Surgical neurology international},
year = {2026},
month = oct,
doi = {10.25259/sni_810_2026},
url = {https://europepmc.org/article/MED/42974563},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Acute ischemic stroke associated with Moringa oleifera and protein powder consumption in a patient on warfarin: A coagulation paradox and clinical blind spot.
AU - Yuta Kobayashi
AU - Akinori Onuki
AU - Kazuomi Horiuchi
AU - Masahiro Oinuma
AU - Ryoji Munakata
AU - Banri Segawa
AU - Kyohei Saito
AU - Hanaka Ito
AU - Yuta Kazama
AU - Zenichiro Watanabe
PY - 2026
DA - 2026/10/09
JO - Surgical neurology international
DO - 10.25259/sni_810_2026
UR - https://europepmc.org/article/MED/42974563
AB - Background As the global consumption of "superfoods" and fitness supplements surges, active patients on long-term anticoagulation face unprecedented, hidden thrombotic risks.Case description We report the case of a 30-year-old male with a mechanical aortic valve who presented with an acute left internal carotid artery terminus occlusion. Despite a history of stable warfarin therapy, his international normalized ratio (INR) plummeted after he began mixing Moringa oleifera leaf powder into his daily protein shakes. He underwent emergent mechanical thrombectomy, achieving expanded Thrombolysis in Cerebral Infarction 2C recanalization and dramatic neurological recovery. Upon discontinuation of the supplement, his INR rapidly recovered to 2.6 within a week without altering his original warfarin dose.Conclusion This case exposes a critical pharmacological paradox: while M. oleifera is widely marketed as a health supplement, it possesses potent intrinsic procoagulant properties and can catastrophically disrupt warfarin efficacy. The concurrent use of protein powder likely enhanced the bioavailability of fat-soluble vitamins, creating a "perfect storm" for rapid coagulation. This evolving dietary trend represents a dangerous clinical blind spot, necessitating proactive dietary screening to prevent life-threatening strokes in anticoagulated patients.
SN - 2229-5097
SN - 2152-7806
ER -