How long for alcohol to affect INR?

[Jkm7]

For the proposed test to have any validity, a very large number of people must participate and careful measure taken of quantity of alcohol consumed including whether hard liquor or beer/wine. Without a large study, one or three or five person's testing is meaningless IMO as any indication that it raises , lowers or does not change INR.

There have been enough people here who have said both that their INR is and others who say their INR is not impacted by alcohol. Some have told of being offered beer or wine with their dinner while in the hospital post op. Other coumadin managers told their patients they have to give up drinking.

 

[ShezaGirlie]

Absolutely no effects here. My cardiologist prescribed one or two glasses of red wine daily which I adhere to.

 

[Protimenow]

JKM7's comment about needing better controls for a study are well stated.
For a good study, the people running the test will probably take pure (as pure as possible) Ethyl Alcohol, measure the exact volume, and mix it with something to make it a bit easier to drink (maybe 50:50 with water, for those who already drink Vodka). They'll probably want a number of test subjects -- although 'anecdotal' reports of only a few subjects may be of some value. They'll have to decide whether or not to use subjects who ARE taking anticoagulants or who are NOT taking anticoagulants (and, if the subjects ARE, there are a lot of other issues -- age, sex, current dosage of anticoagulant being taken, etc.) A good, scientific study could be a long process - and may not be a lot more valuable than doing a test on YOURSELF to see if you, personally, have an issue with alcohol's effects on your INR -- testing shortly after drinking (or even WHILE drinking) may show something, and a test or two, if an effect is seen, in an hour or a few (as long as changes are seen), may help clarify how YOUR body deals with alcohol and INR.

Even testing yourself may not be a reliable test -- if you drink with food, perhaps the food had some minimal short term effect on INR. The next time you drink, your body may react differently. What should probably be assumed is that the effects of alcohol on your INR are probably short-term; the probably won't show up on a test hours (and certainly not a day or more) later.

I haven't seen any reports of alcohol making an INR spike or drop dramatically. (If, for example, that bottle of wine -- or, being a bit more dramatic - that bottle of tequila, suddenly changes your INR from 2.5 to 6.5; or drops it from 2.5 to 0.6 - then there should be reasons to be concerned and to avoid alcohol). I don't think this is the case.

And, possibly because this effect hasn't been observed, researchers probably didn't see much need for spending the money that controlled tests would cost on research that really has little impact on how we live our lives. (And the drug companies couldn't develop a medication that they claim anyone on anticoagulants MUST take when they drink, so that we don't drop dead from a stroke or bleed to death, and charge $10 per placebo)

And Mecretired -- I don't think anyone gets rich doing this kind of research.

 

[Jkm7]

I would not count on any such study any time soon.

 

[Bina]

A past member here shared a story of getting very wasted on a holiday and having a huge spike in INR the following day.
Red wine, in moderation, with a meal is obviously not going to produce those same results.

 

[Protimenow]

Just out of curiosity, did this person 'on holiday' indicate any other things he or she may have done? Perhaps this person got dehydrated; perhaps this person ate a lot of wrong foods -- etc. Did this person make it clear enough that heavy use of ALCOHOL was the ONLY reason for the huge spike?

I agree - I don't think moderate drinking will 'produce those same results.'

 

[Freddie]

No such thing as "wrong foods" while on warfarin!

 

[Protimenow]

Absolutely such things as wrong foods. Perhaps something made with clover (which is what warfarin is derived from) was part of this person's diet. Perhaps this person was given one of the organic clover pills that have been out for a while and are reported to have some great health benefits. Perhaps this person took half a bottle of aspirin for a massive hangover).
Salicylates can also raise the INR. Here's a list of foods that can increase INRs - Herbs and spices high in salicylates include:


Curry powder
Cayenne pepper
Ginger
Paprika
Thyme
Cinnamon
Dill
Oregano
Turmeric
Licorice
Peppermint

Also, from the same website :

Fruits high in salicylates include

Raisins
Prunes
Cherries
Cranberries
Blueberries
Grapes
Strawberries
Tangerines
Oranges

Other substance high in salicylates:


Chewing gum
Honey
Peppermints
Vinegar
Wine
Cider


Note that this does include Wine - so this brings us back to the original question about wine and INR. What I was trying to say (in my last post) was that other things the person 'on holiday' may have done could also have increased the INR -- and, indeed, according to the list above, there ARE things that the person could have eaten - in addition to getting drunk - that could have raised the INR.

Sure, there are wrong things that a person can do - aside from drinking way too much - that can effect INR.


Or did I just miss your attempt at humor?

 

[Protimenow]

After writing about the foods that contain salicylates, it appears that the issue with wine and anticoagulants is less about the alcohol than it is about the salicylates. Salicylate, as you probably know, is what aspirin is - an acetylated form of salicylate (acetylsalicylic acid).
Salicylates block Vitamin K metabolism, so they can also act like anticoagulants. Some people are apparently even more sensitive to salicylates than most, so the effects on coagulation may be even greater in these individuals. Because of varying sensitivities to salicylates, it's probably not possible to make any blanket statements about how these foods (or wine) would change a person's INR.

The effect of wine on INR probably also varies from type of wine to type of wine, vintner, vintage, etc.

I don't know how rapidly the effects of drinking a wine with a high concentration of salicylates would occur. I don't know how long aspirin (or the salicylates in wine) would change the INR. I'm guessing that the red wines may have higher salicylate concentration than the whites (assuming that the salicylates are concentrated in the skin of the grape) and that dry wines also probably have higher salicylate concentrations (more of the grape is still in the wine), but these are only guesses.

Probably the best advice was already made before -- moderation.

 

[dick0236]

:rolleyes2:

Absolutely such things as wrong foods....
....Salicylates can also raise the INR. Here's a list of foods that can increase INRs
...Sure, there are wrong things that a person can do - aside from drinking way too much - that can effect INR.
?

For the benefit of those new to warfarin....most of the foods listed in that post, with the exception of wine, are high on my list of favorite things too eat or drink, and have caused little, or no effect, on my INR. When I first went on warfarin, there were no "forbidden food" lists and it was years before I learned that Vitamin K could potentially be a problem. My "philosophy" has always been to eat or drink what I enjoy, but to use moderation, especially with foods that I know are very high in vit K.

I've hesitated to post on this thread......but what the hell:rolleyes2: For twenty plus years after my surgery, I abused alcohol but maintained a stable INR on a dose of about 70mg/wk of Warfarin. For the past twenty years, I have totally abstained, with the help of another support group(AA), from alcohol and my dose has lowered to about 35mg/wk....so I guess you can say, in my case, maybe, alcohol raised my INR??? Like
everything else, drinking.....in moderation, should pose few problems.....it's the definition of "in moderation" that causes problems.

 

[AgilityDog]

Dick, I think you had it backwards - your alcohol consumption lowered your INR, or caused a change in metabolism which required a higher dosage of coumadin when you were drinking. That's the opposite of what I would have expected, but we keep saying alcohol can either raise or lower your INR. We just can't be sure.

Congratulations on your sobriety.

 

[Protimenow]

A lot of the things in the list that are supposed to contain salicylates and would contribute to raising your INR appear to be items you probably wouldn't go overboard using (except, maybe, some of the fruits).

The overall thread here is moderation, as many have said. If someone does happen to go overboard - maybe drinking a case of red wine one night - it probably wouldn't hurt to test the INR. Other than that, I don't think I'd worry much, either.

 

[New Guy]

Andy,

I want to join you in your INR study. It sounds fun. I'm doing my own little study now. Before AVR I liked to drink my wine. Now 7 weeks post op I've been drinking it again, and I mentioned it to my clinic two weeks ago and they were surprised to find me still in my INR range. (I only had 1 bottle of wine the previous week of that test) I test again Friday and have been purposefully drinking each eve this week to see what effect it will have. I will report my results this weekend.

Doug

 

[MarkU]

In ten years I've personally never seen any correlation between my moderate alcohol consumption and my INR. I define "moderate" as a couple of glasses of red wine with dinner and maybe a bit more on the weekends while watching sports on TV.

Mark

 

[Protimenow]

Andy,

I want to join you in your INR study. It sounds fun. I'm doing my own little study now. Before AVR I liked to drink my wine. Now 7 weeks post op I've been drinking it again, and I mentioned it to my clinic two weeks ago and they were surprised to find me still in my INR range. (I only had 1 bottle of wine the previous week of that test) I test again Friday and have been purposefully drinking each eve this week to see what effect it will have. I will report my results this weekend.

Doug

The surprise by your clinic that drinking some wine a WEEK earlier didn't kick your INR out of range isn't surprising, from what I've seen others write about their clinics. From what I've seen here, it's probably a safer bet to use the dosing charts and some of the expert advice here, from people who are actually managing their anticoagulation as if their lives depended on it (which is the case with most of us), than listening to poorly trained 'professionals' who often have little idea how warfarin works, how to adjust dosage, or the effects of diet or activity on INR.

 

[mecretired]

Amen to that, Protimenow. I have only been on Warfarin for 4 months. I go to the lab, the next day the lab calls my coumadin clinic and they call me. Anyway, the last time my INR was down the clinic increased my dosage on Saturday and told me to recheck on Monday. I had to tell her that Monday was too soon--that the dosage increase wouldn't have shown up yet. If I had rechecked on Monday, the INR would still have been low and my dosage would have been unnecessarily increased. We, whose lives are at stake, are much more knowledgeable and educated about INR etc. I really hope that my ins co will pay for my monitor and that I can eventually self dose. I know that if I ever have a problem I will have lots of help from all you guys. Mary

 

[Jkm7]

Mary,
I'm curious, if you don't mind.
When you told the clinic that checking on Monday after a Saturday change in dose was too soon for it to show up, what did they say? Did they argue the point or agree you should wait until to Tuesday or Wednesday to retest?

 

[mecretired]

They agreed and told me to retest on Tuesday--I really thought I should have waited until Wed. But it worked out. They just don't have the vested interest that we do and don't pay as close attention. Believe me, I have learned enough from this site that I will review and probably double check any changes they tell me to make.

 

[Jkm7]

Thank you for your response. It interested me and I'm really happy they were open to discussing it with you and agreeing with your approach.

 

[Protimenow]

Amen to that, Protimenow. I have only been on Warfarin for 4 months. I go to the lab, the next day the lab calls my coumadin clinic and they call me. Anyway, the last time my INR was down the clinic increased my dosage on Saturday and told me to recheck on Monday. I had to tell her that Monday was too soon--that the dosage increase wouldn't have shown up yet. If I had rechecked on Monday, the INR would still have been low and my dosage would have been unnecessarily increased. We, whose lives are at stake, are much more knowledgeable and educated about INR etc. I really hope that my ins co will pay for my monitor and that I can eventually self dose. I know that if I ever have a problem I will have lots of help from all you guys. Mary

Mary:

I'm concerned when you say 'the next day, the lab calls my coumadin clinic.' What would happen if your INR was way out of range? Would they still wait to call the clinic? If your INR was way high, and you didn't know better, you may have taken another dose that was too high before you even heard from the clinic. If you INR was low, similarly, you may have gone longer than you probably should - and underdosed again - before hearing from the clinic.

Personally, I'm glad to be able to do my own testing and dosage adjustments - and I'm sure a lot of others on this forum are similarly pleased to be able to control their INRs.

There are many horror stories on this forum about people having problems with their insurance companies eventually agreeing to pay for meter and/or supplies. I hope your insurer is enlightened enough - and your doctor is confident enough in your abilities to self test and/or self manage - that you'll be able to easily get your meter and supplies. For myself - being uninsured and not of Medicare age, I took a slightly different direction, buying a meter on eBay and asking a doctor friend to order the strips. (He ordered, and I paid - this course was considerably less money than him prescribing and me going to a medical supply company that filled the prescription) I may not have the newest meter available, and some people here hate the idea that I didn't buy from an approved retail source for meter and strips, but my 'used' meter and new strips are working fine for me. (If you choose to go this route, you may want to steer clear of CoaguChek and CoaguChek S because supplies may be unavailable after October 2011. The CoaguChek XS is fine - it's the current model offered by Roche. The InRatio and InRatio 2 are fully supported by their manufacturer - and both use the same strips. The ProTime meters - both the 'classic' and the ProTime 3 - are also supported and the strips work in both. With the exception of the CoaguChek S, the other meters I mentioned have quality controls built into the strips, so the likelihood of an accurate test with any of the meters, if done correctly, should be quite high. Of course, please consider that I am NOT telling what to do -- the choice is entirely yours -- this is what I, personally, would do if I had a close relative in need of a meter and strips who is uninsured or whose insurance company refused requests for self-testing).

Your insurance company may also be willing to let you go with Alere or Phillips, which provide the meters and strips, and notifies the doctor of the test results that you report to them. Others here will be much better able to point you in the right direction for getting to companies that know how to deal with insurance carriers.