Valve Decision For 44-year old who loves beer

[Pat Heaney]

Hi everyone. New to the forum. I am a 44-year old man. Well, after monitoring my bicuspid aortic valve for years, I am scheduled to have valve replacement and aneurysm repair in a few weeks (aortic stenosis is severe; root dilated about 4.2). My surgeon seems to be pushing a mechanical St. Jude valve given my age but she has good things to say about the new Inspiris Resilia tissue valve as well. I am very active and love downhill skiing, cross country skiing, water skiing, and several other activities. Surgeon is confident I can continue with all these activities even if I go for a mechanical vale and have to take thinners.

My main concern with the mechanical valve is warfarin’s interaction with alcohol. I love beer (I do not drink anything else). On an average weekday I have about 3-4 super light Miller 64s (Miller 64 is 2.2% alcohol-not even real beer). But I do have 4 real beers on most Friday and Saturday nights (plus some 64s mixed in) and maybe 3 beers on Sunday. 4-5 times a year I drink 8-10 beers throughout the day at get-to-togethers and special occasions.

My question is whether this level of drinking is dangerous on warfarin/thinners?




Thank you.

 

[Agian]

No problems.

 

[WillieR]

Well, no Dr will ever tell you it's okay to drink more than. 2-3 drinks per sitting but I had very similar drinking habits to you before getting my On-x mechanical valve. I still drink 4-5 beers at a sitting with no problems, and occasionally a few times a year to 6-7 i.e. bachelor parties, etc. I try to stick to light beers Coors, Miller Lite, etc. I have cut back substantially though. Physically I don't feel any different than before after having a few but I am more concious that I may have elevated INR. The alcohol can also affect how your body processes the Warfarin so you just need to start slow and see how your body responds. My Drs. Official advice was no more than 2 drinks per sitting and 5 max a week.

I also play pickup hockey, snowboard (just cruising, no jumps, rails etc.) and generally any outdoor activity I feel like. You will bruise a bit more so just have to take it a bit easier. Once you are on Warfarin a while and get a sense of how your body reacts you'll get more comfortable with what you can tolerate. I've found the effects of Warfarin aren't as bad you read about in some places. P.s. my range is 2-3 and I'm almost always between 2.4-2.6.

 

[DDT77]

Your choice: redo in a ~ decade, or some possible moderation of beverage? Just had a couple of 11% dragon's milk as you indicate - miller 64 is not beer... go mechanical, get comfortable with it and warfarin, carry on. I'm early forties, 2nd OHS was what you are facing. My INR starts to go vertical after 3 a night, **** happens -- deal with it.

 

[dick0236]

At 44 I'd go with mechanical. A few beers on the weekend should have, little if any, effect on warfarin. As a matter of fact, I got a 12oz can of Schlitz beer while I was post AVR in the hospital. Back then there were not a lot of diuretics around and the docs thought the beer would help me not to retain water. Not sure it worked but it was something I looked forward to each evening. FWIW my mechanical valve and warfarin have had almost no effect on the way I've lived my life.

 

[pellicle]

... Surgeon is confident I can continue with all these activities even if I go for a mechanical vale and have to take thinners.

I am too

Finland -20C or so

I go "bush" not track so much


and lakes of course


Meanwhile back here in Australia I regularly behave myself on safe equipment:


and I can say this is the best way to make a cappuccino


the usual advice given is don't get so sh1t faced as to fall down stairs.

I've been helping a nice mid 20's Adelaide Lad who's a bit of a beer drinker too to manage his INR and we've done pretty well.

 

[Gustav]

No issues. Now 40 op at 37 same as you opted for On-x. Drinking routine never changed. Wine (2 glasses) on a daily basis and the occasional weekend vodka/gin. INR never varied. Pretty fit with 3 time weekly personal training which included moderate weight lifting. I don't regret going for mechanical.

 

[Sten Osis]

I was 49 when I had AVR with a St. Jude Regent. I chose mechanical because the surgeon believed, at my level of activity, a bio-prosthetic valve
might not hold up beyond eight years. That was enough for me. Who wants to go through this again?
There's been no change to my activities, which are off-road (mtb) and road cycling, skate skiing, running. I'm riding at a pace that's not much
slower than when I raced the mtb and road bikes, but that's because I'm not training to race. With regards to the alcohol, I have what amounts to 3 bottles of beer nearly every day, sometimes more. My doc wasn't too thrilled with the volume, but said it was more important to be consistent, so that my INR would be stable.

 

[Gustav]

Silly question re skiing. I'm no pro but gave up any skiing trips since I had my intervention do you guys think that the occasional fall could actually cause any permanent damage to the valve apart from bleeding risks?

 

[Sten Osis]

Silly question re skiing. I'm no pro but gave up any skiing trips since I had my intervention do you guys think that the occasional fall could actually cause any permanent damage to the valve apart from bleeding risks?

I've had some pretty good wipe-outs on the mtb and the valve is still good. I think any impact that could damage the valve would probably be deadly anyway.

 

[tom in MO]

You will read all kinds of things about warfarin and alcohol, those that tell you not to drink or drink less are from people who are afraid you will fall down and get a severe concussion with bleeding. Warfarin increase the clotting time of your blood. So if your INR is 2.5, it will take 2.5 times longer for your blood to clot compared to a normal (?) human. There is no significant interaction between alcohol and warfarin unless you drink so much you puke up that day's dose

At age 44, drinking 4-6 beers a day, your biggest health risk, with or w/o warfarin, is weight gain as you get older and your body changes.

 

[Protimenow]

An INR of 2.5 should make your blood take 2.5 times AS LONG as an INR of 1.0.

I wouldn't worry about beer, or any other alcoholic drink damaging a mechanical valve. I'm not even sure about beer having any effect on your INR. And, as others have said, the real fear is getting falling down drunk - and actually falling down HARD.

And, as others have said, a key to good INR management is consistency. Try to drink roughly the same amount of beer daily -- if it affects your INR, adjust the dosage of warfarin and maintain the dose (and the beer) at a level that assures a fairly consistent INR.

(I've had my St. Jude mechanical for 28 years - I'm almost glad that I don't have to consider the possibility that they may be able to repair, through a catheter, a failed tissue valve a decade from now. I probably wouldn't take that gamble).

 

[Superman]

The only other thing I’ve heard some chatter about is Warfarin being metabolized by the liver. Heavy drinking is not kind to the liver.

Commitment to a lifetime of Warfarin and what might happen down the road in the event of liver damage due to alcohol might be something to look into.

In re-reading the OP, they seem to be consuming 2 normal drinks a day, every day with double that or more daily every weekend. How much is too much? I really don’t know.

 

[Pat Heaney]

Thanks for all the input. Pretty sure I’m going with a mechanical. Maybe an ON-X.

 

[user 16827]

Silly question re skiing. I'm no pro but gave up any skiing trips since I had my intervention do you guys think that the occasional fall could actually cause any permanent damage to the valve apart from bleeding risks?

Like Sten i have had some serious bike tumbles, including a shattered shoulder & surgery

Valve took it no issues at all

The extra bruising was very impressive though

Start the skiing again and enjoy life

 

[Dcano1007]

I am 32 and also love beer but don’t drink as consistently as you. I can go a month without a beer and suddenly drink 4 IPAs or a pitcher of Yungling. If I were you I would plan on checking INR weekly. Ohhhhh, I also have a St. Jude mech.
Moderation is key!

 

[PAN]

Hi Pat,

I'm a similar age but still waiting on the go ahead for surgery. I had wondered about the beer question to. I have learned not to worry about that at all. Based on the advice here I plan on easing back into it and initially monitoring a little more closely to understand my reactions, if any between AC and alcohol. The likely outcome is that 1 or 2 beers to a moderate night out will have little or no impact. I wouldn't worry about it at all. I am not.

My preference is to go mechanical, 100%. Live my life and work the AC in there.

Wish you the best of luck with your operation.

My ascending aorta is also about 4.1. I didn't know they will repair/replace at this diameter ? I understand the increased risk of this worsening due to BAV, even after valve replacement . Another topic to cover in more detail at my next consultation.

All the best, a Guinness tonight I think

 

[Protimenow]

There may be a bit of confusion about the effects of 'alcohol' and the beverage that contains the alcohol with the effect on INR. There was a paper a few years ago that said that dark red wines, loaded with tannins (which give the wines their color and flavor and, presumably, some level of Vitamin K) may have an impact on INR. Beer, distilled liquors, white or blush wines, don't have these factors (or, in the case of pink or white wines, may have small amounts).

I don't extremely rarely drink wine or beer - by choice (and because of other medications that I take) - so I can't speak about the effect of these beverages on INR, but, as others have suggested, the key is to drink consistent amounts (if you can), and then adjust dosing of your warfarin.

If you're inclined to drink a gallon of Burgundy, Merlot, or other dark red wine daily, you may have more problems than just your INR -- but -- if you drink this amount of dark red daily, you should be able to adjust your warfarin dosing to accomodate for the wine's effects.

 

[pellicle]

a Guinness tonight I think

a fine choice (says the Irishman in me)

 

[pellicle]

Thanks for all the input. Pretty sure I’m going with a mechanical. Maybe an ON-X.

what ever you pick, have a beer and think about it