Beer and INR

[Jimmy]

I am going to make this short and sweet, I love my beer.Since my aortic valve replacement ( St. Jude mechanical) and my quadrupal bypass on Dec. 13, 2004 my INR has fluctuated between 1.5 and 7.8 without changing my life style, I try to eat right I do not smoke (anymore) I could use more exersise but I get frustrated mostly because of the valve, the situation is that if I do not drink beer for a week or I do drink beer up to 7 beer a day over a 12 hour period how much can this effect my INR. I only adjust my INR by 10 to 20% a week when it's out of whack. I am under a lot of stress, mostly financial but also I had to retire (at 62) which I was not prepaired to do and I feel that my mental state has a lot to do with this. Any feedback would be appreceiated because even my Dr. is at a loss but he's not the best when it comes to INR. The funny thing is part is that a freind of mine also has a St. Judes aortic valve and he drinks 3,4,5 beer every day and maybe a few more on Sat. night when he goes out and his Dr. told him "just be consistant with what you'r doing" and he is always within range. So what's the answer? Does anybody drink beer and not have a problem with their INR?

[ClickerTicker]

Jimmy - my cardiologist gave me the same advice as your friend, be consistent. I drink beer, a pint most nights, sometimes 2. Normally followed by a few glasses of wine - never had a problem with my INR.
The thing not to do is to abstain all week, then binge at the weekend. It's the same for beer as for anything else that affects your INR, greens, other medication, etc.
Also, as is often said here, "dose the diet, don't diet the dose".

[geebee]

I don't drink beer but I do have a glass of wine or Bailey's a couple of times a week. Since I am pretty consistent, it has not affected my INR.

There have been a few times where I have had more than a couple (parties, special dates, etc.) and I just make sure I test a couple of days later. Since I home test, I can keep good tabs on where things are. I sometimes have to make a slight change but usually do not.

The only concern I have about alcohol is I do not really know if it affects your blood's clotting ability without affecting your INR (kind of like aspirin) so I try not to overdo it.

[Natanni]

Hi!

My husband started to have a few beers sometime in December or January after having his AVR in Sept. He started off having a glass of wine, sometimes two maybe 3 days a week. His INR was not affected by this, and then he tried throwing in a beer here or there. Still no affect. Lately, he has been having 1-2 beers Sat and Sun or 3-4 beers on Saturday, still no effect on INR. Because I was unclear if alcohol would have an immediate effect on INR or if it would take 1 day, 2 days or maybe 3.....we tested his INR at home (he has an INRatio) immediately after consumption, at 12 hours and 24 and at 48...the entire time (yes, I know...wasting strips...), Nathan stayed in range (this was the 4 beers in one night episode). I guess we are just trying to find his boundaries at this point. Nathan feels he will never need more than 4. He also makes a point to eat moderate sized salads, brocoli and kale a few times a week. Another point about alcohol is of coarse, it is not the greatest thing for the heart.

More people will be by shortly to help. Also be sure to stop by the Anticoagulation board or do a search under alcohol.

[William]

Try and be consistent with the drinking. Binging will affect the INR the most. I have a few drinks almost every night and know when I'm below/over the amount I normally drink. Try to drink the same amount each time. I know, it's hard, but possible. Will

[Blanche]

Jimmy:
You love your beer......and I sure loved mine. However, do you love your life? In my early years I spent some time being commode-hugging drunk, and I thought that was fun...and some of it was. But, I was not on Coumadin/Anticoagulation. The problem I had was I drank, I got stupid...I got stupid, I took chances....I took chances, I fell down and hurt myself. Now, if I had been on Coumadin, I could have died. Drinking seven beers is a death wish. If stupidity doesn't get you, your liver or stomach will.

Alcoholism isn't a sin, it's a disease and can be treated. You can talk with your doctor about your depression and problems. Perhaps there are some medications that can help you through your rough patches. Alcoholics Anonymous has experience dealing with people with all sorts of medical problems. They have people who have been successful in overcoming drinking problems who act as supporters for others in like situations.

You really do need to take some positive steps here. I wish you the very best.

Blanche

[Karlynn]

The problem with alcohol binging is not so much the danger of a higher than theraputic INR, but a stomach bleed. We have had many discussions on the affects of alcohol. If you do a search on it, you'll get many threads.

[catwoman]

The problem with alcohol binging is not so much the danger of a higher than theraputic INR, but a stomach bleed. We have had many discussions on the affects of alcohol. If you do a search on it, you'll get many threads.

Another problem: getting falling-down drunk, hitting your head and having a subdural hematoma.

[DrAllan]

Jimmy,

Lets talk about the effects of alcohol. Seven beers a day is far in excess of healthful consumption. It is very likely that you have some degree of cirrhosis, which is permanent scarring of the liver. Hence, you have decreased liver function. With enough cirrhosis a person does not make enough clotting factors purely on that basis, with no additional help from anticoagulants. Second, the liver preferentially metabolizes alcohol before making clotting factors. So, in general Coumadin will act very erratically in your body. Depending on many factors, especially your blood alcohol levels, your production of clotting factors is erratic and unpredictable. The advice ?keep it constant? is said frequently on this site in relation to vitamin K containing foods. Many have applied the same statement to that of alcohol consumption, but in my opinion the similarities are not accurate. With a valve, you are anticoagulated in order to try to prevent an embolic stroke. With decreased liver function and the vacillation of INR that alcohol will have on you, the risk of embolic or hemorrhagic stroke is higher in you than in the general population.

All said, 1-2 beers a day with prior good control of your INR would probably not reduce your life expectancy in relation to ACT. However, your underlying coronary artery disease in addition to the valve does have a predictive value for decreased life expectancy.

Best to you


This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

[allodwick]

We have this discussion every two months it seems. A guy who drinks 7 beers in 12 hours and complains about his INR fluctuating is not going to listen to advice, if our history is any predicytion of the future. I suspect that when Jimmy finds out that he is not going to be supported in overindulgence, that he will fade from this site - and probably from this life - before too long. I see people every week who live their beer or drugs more than they love life and they are frequent frequent flyers at the hospital. Nothing will convince them that they need to develop some stability to do well on warfarin.

[Jimmy]

Hi Guys'
The first thing I would like to address is Blanche's statement. I am not or have been a "falling down drunk" or a "commode hugging drunk" but I still enjoy my beer, you say that you were so I guess that it's a good thing that you quit, I cannot remember the last time I was even the least bit drunk, happy yes, drunk no. I am a sipper, yes an all day sipper, for anybody that drinks anything all day whether it be coffee, soda, water etc. you can see how someone can go thru a lot of liquid in a day. I am not trying to bail out off this I know that 6 or 7 beer every day (almost every day) sometimes 3 sometimes nothing for a week, I know that it's not good for anybody, especially someone thats had open heart surgery, so I plan on cutting down but I still wonder how much worse it is for someone thats had surgery than a "normal" person. I guess that I feel sorry for myself and I really do apoligize, but for me it's so tough to give up everything, foods, smoking (the best thing I did) and a happy go lucky lifestyle. Now to Al lodwick: hopefully you are wrong I am not going to fade from this site or this life for a while, as a "Dr" you should be able to see that I am having trouble dealing with these issues and I am reaching out for help, I do not need criticism I need guidance and support, I thought I could get it from this site. All of the people have been so supportive on this site I hope I can be here for quite a while. Thanks to all, hope to get feedback.
Jimmy

[allodwick]

Jimmy we can support you. There is just no way that you can continue to have 7 beers in one day and expect to have a stable INR. You have to accept the risk of a fatal bleed if you continue on the same course. As you age alcohol has more effect on the lining of your stomach. Once you reach the critical age and the critical stae of the lining of your stomach you will start to bleed. Warfarin will make it very difficult to get it stopped. The problem is that there is no way of predicting when the bleed will happen.

[Jimmy]

Well guys, here's another chapter in fluctuating INR, 3 weeks ago I was 6.4 after taking 40.5 mg for 2 weeks and was 2.7 and 2.6 for both those weeks, skipped 1 dose and cut back to 37 mg for that week and dropped to 1.8 but stayed with 37 mg for that week...tested again and was 2.7 (perfect) stayed on 37 mg for the next week and tested yesterday at "6.8" btw cut my beer consumption to 3 beer a day even went 8 days with no beer to see if it would make a change still was all over the map....up and down. What I'm going to do now is skip a dose tonight then go back to my 37 mg (acctually it will be 31 mg) for this week, and probably test in 3 to 4 days from now. I am basically at a loss maybe it's something I'm going to have to live with but it sure is frustrating. Does anybody else fluctuate like this?

Aortic St.Judes
Quad bypass
Dec. 13, 2004

[allodwick]

If you do not have lupus, antiphospholipid antibody syndrome, alcoholic liver disease, or Budd-Chiari Syndrome, then the cause of the fluctuation is almost surely something that you put in your mouth. I still suspect something to do with the beer. If you had several beers and your INR was high and the warfarin was adjusted downward the stopping the beer for eight days would have caused the INR to drop even more because your warfarin dose was adjusted for high beer consumption. You need to be consistent. Stopping beer for 8 days is an inconsistency. The INR fluctuating when you did this is just what should have been expected to happen. Eight days sounds like a long time but when you are dosing warfarin over a 7 day period it is just aanother confounding factor. You have to pick a number of beers that you are going to drink daily and then drink that many every day until you get the INR to come in at a reading in your range for two weekly tests in a row until you can draw any valid conclusion. Testing and changing the warfarin dose more often than once per week is the biggest complaint that I get from people who cannot get their warfarin adjusted. It takes 3 to 5 days for the effect of the last warfarin dose chnage to take effect. Testing and changing the warfarin dose more often than just assures that you will be out of range most of the time. If you are in range, it will just be by accident and you will probably be out again for the next test. Pick a warfarin dose and a beer consumption level and maintain that for one week between testings. Then you will start to get an idea of what the proper warfarin dose will be.