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Tylenol, Blood Thinner May Not Safe 98-03-03 CHICAGO (AP)

	People who often take Tylenol or any other form of 
acetaminophen along with a widely used blood-thinning drug 
may risk deadly internal bleeding, say researchers.
	The study confirms a hazard that has been known for 
decades but not talked about. Frequent doses of acetaminophen, 
the active ingredient in Tylenol, increase the blood-thinning 
effect of warfarin, a drug used to prevent strokes and heart 
attacks, researchers warned in Wednesday's Journal of the 
American Medical Association.
	"While acetaminophen generally is a very safe drug for 
pain and fever, people on warfarin who take Tylenol for 
at least seven days in a row should be closely watched for
bleeding," said the study's lead author, Dr. Elaine Hylek of 
Massachusetts General Hospital.
	Warfarin, also known as COUMADIN, is taken by millions 
of people with a heart condition called atrial fibrillation 
to prevent the formation of blood clots that could cause strokes. 
It is also taken to prevent clots around replacement heart valves
and to dissolve clots in the legs or lungs. People taking warfarin 
often choose acetaminophen for everyday pain relief in the mistaken 
belief that it will not thin their blood further, the researchers 
said. Aspirin is known to thin the blood and both aspirin and 
ibuprofen, another widely used pain reliever, can damage the
stomach lining.
	Warfarin's effects can be altered by many things - illness,
other medications, even certain foods - so treatment involves a 
delicate balance: Too little blood-thinning can cause a clot that 
could travel to the brain and cause a stroke; too much thinning 
can lead to deadly internal bleeding. Patients on long-term
warfarin treatment usually get a monthly blood test called an INR, or
international normalized ratio, that measures blood thinness.
	The expert, Dr. William R. Bell of Johns Hopkins University 
School of Medicine, said if patients must take warfarin and 
acetaminophen at the same time, their blood thinness should be 
measured once or twice a week and their INRs should not exceed 4.
	JON'S NOTE: The dose of Tylenol that caused dangerous reactions
in some people was relatively low - just a few Tylenol per day for
a week, in addition to their Coumadin. BE CAREFUL!