426) A 70-year-old man with history of atrial fibrillation and metallic mitral valve presents to the out patient clinic for follow up. He has been taking warfarin for the past 5 years. His INR has been in therapeutic range between 3.0 to 4.0. However, over the last one month his INR has been in the range of 1.5 to 2.0 . His other medical problems include moderate osteoarthritis and mild cognitive dysfunction. He started taking Glucosamine supplements for “preserving his joints “and Ginseng to slow “ageing of his brain” about two months ago. He has also been started on Aspirin by his cardiologist about 1 month ago. On examination, he is afebrile and vitals are stable. Abdominal examination is benign. A repeat INR is still sub-therapeutic at 1.5. Which of the following is the most appropriate management?
A) Increase Warfarin dose by 20%
B) Stop Glucosamine and repeat INR in 1 week
C) Continue Warfarin at same dose and repeat INR in 1 week
D) Stop Ginseng and repeat INR in 1 week
E) Stop Aspirin, increase Warfarin dose and repeat INR in 1 week