Acute ischemic stroke associated with Moringa oleifera and protein powder consumption in a patient on warfarin: A coagulation paradox and clinical blind spot

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.