Question? Alcohol & Blood Thinners

[dkapuscik]

OK, I know that alcohol seems to have a natural blood thinning quality. I have reviewed the web and see no studies that show alcohol and wafarin thin more when combined. When a person has overindulged, do the reading truly represent the anticoagulation or does the alcohol alter those readings to produce a false reading when in fact, it may be stable?

 

[Karlynn]

Drink in moderation and it shouldn't matter. Tying one on a few days a week or more is going to mess with your INR. But the big danger is a bleed in the stomach due to irritation of the lining from excessive alcohol

There have been lots of posts on alcohol here, so do a search on it and you get lots of hits.

 

[Ross]

But the big danger is a bleed in the stomach due to irritation of the lining from excessive alcohol.

And as I can now testify, you don't even have to drink to have a GI bleed and you certainly don't want to go there either!

 

[Cooker]

If you like to over indulge an alternate form of intoxicant might be in order. These have been discussed at length. As you might imagine there are as many opinions as substances.

The best bet is moderation.

Cooker

 

[Ross]

If you like to over indulge an alternate form of intoxicant might be in order. These have been discussed at length. As you might imagine there are as many opinions as substances.

The best bet is moderation.

Cooker

Hey silly, we are here to promote good heart health, not promote self destruction.

 

[Guest]

It is not the INR that is the problem, it is the damage that the alcohol produces. I know it is fun now, but it is really self-destructive. Please believe Ross. He has been there and done that - no matter how you want to look at it. You went through life saving surgery, please cut back on life destroying activities. I've seen two guys who wound up in jail for a day or two on minor charges who had paralyzing strokes because they did not have their medication with them and the jail wouldn't give meds because they were only going to be there a few days and did not have time to have their doctor check them out.

 

[davidfortune]

Consistent, moderate alcohol consumption is typically not a problem. Binge drinking - leave it for foolish college students. You're too wise/mature (please translate old, over the hill, "fuddy duddy", or whatever other moniker applies to those of us over 40 ...) now to need binge drinking.

 

[Guest]

I just re-read my post. I did not mean to leave out the part about moderate drinking. I have never seen a problem with people who have two drinks per day or less. Too many people read that and translate it to 14 on Saturday and none the rest of the week averages out to 2 per day. By that logic then you could just take all of your weekly warfarin dose on one day each week and be done with it.

 

[mtkayak]

I borrowed this from the AHA 2006 Guidelines for Valve Patients:

"The risk of stopping warfarin can be estimated and is relatively slight if the drug is withheld for only a few days. As an example, in a worst-case scenario (e.g., a patient with a mechanical prosthesis with previous thromboemboli), the risk of a thromboembolism when the patient is not taking warfarin is 10% to 20% per year. Thus, if therapy were stopped for 3 days, the risk of an embolus would be 0.08% to 0.16%. There are theoretical concerns that stopping the drug and then reinstituting it might result in hypercoagulability or that there might be a thrombotic "rebound." An increase in markers for activation of thrombosis with abrupt discontinuation of warfarin therapy has been observed (964), but it is not clear whether the clinical risk of thromboembolism increases (965). In addition, when warfarin therapy is reinstituted, there are theoretical concerns about a hypercoagulable state caused by suppression of protein C and protein S before the drug affects the thrombotic factors. Although these risks are only hypothetical, individuals at very high risk should be treated with heparin until INR returns to the desired range"

If the 2 guys arrested were paralyzed from strokes due to not taking their Coumadin aren't they the execption rather than the rule. If I'm reading this correctly that seems like a VERY low percentage.

 

[Ross]

I borrowed this from the AHA 2006 Guidelines for Valve Patients:

"The risk of stopping warfarin can be estimated and is relatively slight if the drug is withheld for only a few days. As an example, in a worst-case scenario (e.g., a patient with a mechanical prosthesis with previous thromboemboli), the risk of a thromboembolism when the patient is not taking warfarin is 10% to 20% per year. Thus, if therapy were stopped for 3 days, the risk of an embolus would be 0.08% to 0.16%. There are theoretical concerns that stopping the drug and then reinstituting it might result in hypercoagulability or that there might be a thrombotic "rebound." An increase in markers for activation of thrombosis with abrupt discontinuation of warfarin therapy has been observed (964), but it is not clear whether the clinical risk of thromboembolism increases (965). In addition, when warfarin therapy is reinstituted, there are theoretical concerns about a hypercoagulable state caused by suppression of protein C and protein S before the drug affects the thrombotic factors. Although these risks are only hypothetical, individuals at very high risk should be treated with heparin until INR returns to the desired range"

If the 2 guys arrested were paralyzed from strokes due to not taking their Coumadin aren't they the execption rather than the rule. If I'm reading this correctly that seems like a VERY low percentage.

No offense, but this is playing the numbers game. Numbers don't mean squat if it happens to you. This is why I hate statistics. It might as well be gambling.

 

[mtkayak]

So, in fact, you stand a better chance of getting killed in an auto accident than you do from dying from a blood clot but you still continue to drive. Maybe we should all trade in our cars for bikes.

Just trying to make a point

 

[davidfortune]

In fact, approximately 1 in 7,000 Americans die in auto accidents each year. This is a statistical probability of .0143% per year. This equates to 0.000117% chance over 3 days (using the example same arithmetic cited in the article) - not anywhere close to .08% to .16%. If we are going to use statistics inappropriately, please at least abuse the correct statistics.

Statistics can NEVER be applied to an individual. They are ALWAYS applied to a social group. Statistical probabilities are ILLUSTRATIVE of your individual risk but ARE NOT your actual individual risk. Your actual risk is impossible to determine until/unless the risk happens to you (in this case a blood clot). When it happens to you, your individual probability is at 100%. Let's be careful not use statistics like a drunk man uses a light post... "for support rather than illumination". Use statistics for illumination in decision making not as predictors of the future or as a defense of an ideological position.

I believe Al's point was not an analysis of the statistical likelihood of thromboembolism if warafin is missed. I believe his point was; "Don't do stupid things that create bad situations for yourself." (i.e. exercise wisdom and maturity in your decision making).

 

[jeffp]

Let's be careful not use statistics like a drunk man uses a light post... "for support rather than illumination".

I love that line! I'm going to have to steal it and find a place to just drop it into a conversation. "for support rather than illumination"...that's great!

 

[Karlynn]

Let's be careful not use statistics like a drunk man uses a light post... "for support rather than illumination".

.......I believe Al's point was not an analysis of the statistical likelihood of thromboembolism if warafin is missed. I believe his point was; "Don't do stupid things that create bad situations for yourself." (i.e. exercise wisdom and maturity in your decision making).

I liked that line too David. Statistics are not my favorite thing and as Ross points out, it doesn't amount for much when you end up being in that "small likelyhood" group.

But David's comment I quoted above made me think - how would statistics change if we factored out those who did dumb things and made unwise choices that led them to be on the bad side of statistical evidence. For instance, someone who drove drunk and it resulted in traffic fatalities, or someone who was always forgetting to take their warfarin and had a stroke. What would the statistics look like then. I'm sure they'd look a lot better. Accidents happen with out any intelligence or maturity issues. But many happen because of intelligence and maturity issues.

So ya... exercise wisdom and maturity in your decision making!

 

[Guest]

They are probably the exceptions but I see so many people that it is not unusual that I have seen some especially since prisons are one of the top industries in the area.

One of my best friends worked at Supermax and when we were watching TV at lunch the other day the story about the guy escaping and killing someone at Virginia Tech was on. He commented that 80% of all prison escapes occur during trips outside the facility for medical attention. This is why getting medical care is often slow because they have to schedule guards to take them out. When a Supermax prisoner is out they usually have their hands crossed in front of them in handcuffs and the right hand is shackled to a guard on the left and the left hand is shackled to a guard on the right. The feet are shackled so that they can barely get one foot in front of the other and a chain runs up from the ankle shackle up to the belt loop on the back of the pants and back down to the other ankle. A guard with a pistol drawn walks in front of the prisoner and a guard with a pistol aimed at the prisoner walks behind them. Quite an impressive procession! If we have to make a follow-up appointment we are not allowed to let the prisoner know when it will be. This is because of the risk of people being there to "liberate" them.

 

[mtkayak]

I like the lamp post too. I would be the one leaning against it for support
Sorry I should have backed up my statement by adding correct statistics. I will not break it down by 3 days of no wafarin vs. 3 days of driving. Hell, I may have a better chance of winnng the lottery in those 3 days.

Here are the facts, plain and simple.

Age 0-45: Leading cause of death is Accidents and adverse effects caused from the accidents with motor vehicle accident leading the way.

Age 45-65: Malignant neoplasms, including neoplasms of lymphatic and hematopoietic tissues

Age 65 and Over: Diseases of heart

Motor vehicle accidents remain a high risk for all age groups.

http://www.disastercenter.com/cdc/

Notice how they use the word HIGH risk. Still makes me wanna trade that car in for a bike

I too believe while dealing with social group you cannot take into account in statistics for individual happenings. But if we were to calculate a situation in detail we may be able to understand in detail individual behavior.

 

[Karlynn]

Mike, I understand what you are saying. We often don't take a look at the statistical risks of behavior that we do daily or several times a day. We assume because so many drive, or ride a bike or drink to excess without repercussions, then it's much safer than things we aren't familiar with.
The more familiar or common-place something is, the more we assume the risk is negligible, when we really just may be lulling ourselves into a false sense of security.

I've asked friends who have expressed to me that they "would never want to have to take Coumadin" if they would rather be insulin dependent or ACT dependent. All chose insulin. This is because Diabetes is so "socialized" in our country. Commercials for nifty testing machines hawked by Patti LaBelle and B.B. King make it almost seem cool. We don't hear a lot about the drawbacks of being diabetic. Heck, you just test, take a little shot and you're all set. Our best friend's daughter has been diabetic since she was 9. (Type I) I asked her one time if she would rather have her daughter be a diabetic or be ACT dependent (and she's known me for 23 years so she knows what that means). She quickly answered "Coumadin dependent, no doubt." This is because she knows what it actually means to be a long-term diabetic and she'd rather her daughter had to deal with ACT, than diabetes. (Obviously she'd rather she not have to deal with either.) She knows the statistical outlook for her daughter, whose eye sight, at age 22, already is diminished due to her diabetes and she has been on the verge of diabetic comma 5 times. (One time was when she was with me on a mission trip .) But our society (or at least most of my friends) give little thought to the risks associated with diabetes because they hear so much more about it than they do ACT. It's familiar, so it must be the lesser of two evils.

 

[mtkayak]

I understand what your saying Karlyn and it makes perfect sense. People fear what they don't know. Which is kind of the reason I posted what I did. It would be nice if people understand and can relate it to something they do know. That, is how low of a percentage and risk that it actually is. I just don't want people running around scared just because they missed a couple of dosages or because they drank 6 beers in fear that they might drop dead. We already know how misunderstood ACT is to society.

And don't get me wrong ,I'm very much an advocate for dilligent warfarin management.

 

[Karlynn]

Don't worry Mike! We know where you're coming from. And you're correct - we don't want people to think that straying from the prescribed path is going to end their life.

On the rare occasion that I've over-indulged (as Geebee puts it - I'm a cheap date), my heart doesn't care for it. It gets kind of tachy and I can't get comfortable to sleep. So that's my biggest reason for limiting my adult beverages to 1 or 2. We often talk about alcohol consumption risks in terms of INR and bleeding. But there can be other affects just as concerning.

 

[catwoman]

Check out CDC stats

Check out CDC stats

Mike:

Check out the U.S. Centers for Disease Control's stats -- latest I could find were for 2003, released 4/19/2006.

http://www.cdc.gov/nchs/data/nvsr/nvsr54/nvsr54_13.pdf

short version: http://www.cdc.gov/nchs/fastats/lcod.htm

According to the CDC, there were 2,448,288 deaths registered in the U.S. during 2003. Of those, 685,089 (#1 on the list, 28% of the total) were due to diseases of the heart and another 157,689 (#3 on the list, 6.4%) were due to cerebrovascular diseases. I don't know how strokes due to clots related to anticoagulation failure/mismanagement would be classified.

Coming in at #5: accidents (unintentional injuries), 109,277, 4.5% of the total.

Among infant mortality causes: #1 was malformations, #10 was circulatory. I'm not sure if a cardiac malformation would be listed under malformation or circulatory system.

INRs will drop faster for people on higher dosages of warfarin/Coumadin than those who are on lower ones. Example, a person who needs 12mgX7 of warfarin to stay at 2.5-3.5 will show a drop in INR if a dose is missed, whereas a person who only needs 2mgX7 won't notice as much of a drop.

Also:
Alcohol causes dehydration.
Dehydration raises the INR.
If you tie one on without compensating with additional water/nonalcoholic fluids, the concentration/percentage of warfarin in your blood will increase.

I'm not a teetotaler. I love a Bombay Sapphire martini with lots and lots of olives (not a "dirty" martini) and margaritas on the rocks with salt.
I prefer moderation to having to remember if I made a donkey of myself, like I did at a Halloween party in 1972. Ah, to be 22 again and blame indiscretions on foolish youth!