Does alcohol reduce effectiveness of warfarin ?

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My best pal recently had open heart surgery resulting in a replacement valve & work to correct a leaky valve.

As a result going forward he will be taking warfarin for the rest of his life.

As things stand a couple of months after the operation his walfrin readings are very varied & keep going up & down.

He has always enjoyed 3+ large glasses of wine each day and has continued a similar pattern post operation.

Clearly this intake is way above the recommended 1.5 units for those taking walfrin.

Notwithstanding the obvious impact of such daily volumes for anybody never mind someone having had heart surgery, I do have two specific questions:

1) Could the alcohol be one of the reasons for the lack of stabilisation on his walfrin readings ?

2) Could the alcohol actually have a negative impact on the effectiveness of the Walfrin ie causing increased risk of heart attacks ?

I love my mate to death but am concerned that he may be in denial as to the impact of his continued drinking.

Any advice would be greatly appreciated.

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44 Replies

  • Posted

    I take warfarin and have done since i was a baby.

    Your not supposed to have alcohol while taking warfarin full stop as alcohol thins your blood.

    Dont get me wrong, i'm not saying i have never had alcohol, i have a glass of wine every now and then (like once every few months) and it definatly effects my inr reading, it can make it unsettled for about 2 weeks. Luckily i home test so i can keep an eye on it .

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  • Posted

    He should have been given an instruction booklet with lifestyle instructions. There are thing not to have and others that you can have in moderation including alcohol. Basically it is to keep your alcohol level stable at 21 units a week and no binge drinking.

    The usual advice:

    While alcohol can be a source of pleasure and enjoyment, drinking too much or at the wrong time, can cause problems when on warfarin. Alcohol has a marked affect on the action of warfarin.

    The important thing is to know where the benefits end and the risks begin! 

    We recommend that you should drink the same amount of alcohol each day, thus avoiding big variations in the amount you drink from day to day. The guide to the amount of alcohol that is both safe to drink and good for your general health, is no more than 21 units of alcohol for a man or 15 units for a woman a week.

    1 unit of alcohol equals:Half pint of ordinary strength pub beer, lager or cider

    Small glass of wine

    Single measure of spiritPlease remember that some drinks are stronger than others. The strength of alcoholic drinks is shown on the labels.

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  • Posted

    too much at 3 large glasses I'm afraid, also mixed with liver function, which may have been impaired if he has been a heavy drinker for many years.

    Is he also overweight, he may have a fatty liver, and that also impairs liver function.

    I notice with my husband if I feed him too much dark green food for the week it also affects his levels, so i try to keep it well mixed up with other vegetables, carrots, sweet pototoes, parsnip, beans, pumpkin, and keep the swiss chard, and cabbage, broccoli and other very dark green veges towards a smaller serving even though they are reccommended to us by the dietitian.

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  • Posted

    I had my valve repaired over 2 years ago - I was already on warfarin for 3 years before that due to AF, I drink a couple smallish glasses of wine a night and my readings are fine. Generally it's also food which causes probs with blood readings - I was told not to eat too much salad when I was prescribed warfarin but as I have diverticular disease it's one of the few things I can eat!! It was fine as I had always eaten lots of salad before going on warfarin - the main thing is not to vary your diet too much, I only need to go for my blood check every couple months unless I have been ill and lost weight or taken medication which altered my readings. Try not to worry and maybe suggest for him to only have 2 glasses a day. Wishing him all the best.
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    • Posted

      My favourite vegetable is Brocolli and the INR nurse tells me it is the leafy vegetables cause more of a problem. 
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    • Posted

      Wow, you get ti test your blood every couple of months?! That sounds amazing.

      I have to do mine once or twice a week - hence why i bought my own machine to home test!

      The longest i have ever gone without testing is about 2 weeks because my levels have been very good for months.

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    • Posted

      Having taken it for so long I thought that your body would have been well used to it.

      Nurse said that I was a 'slow responder' in it settling down but this time I have had a six week gap. Will see what tomorrows INR check says.

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    • Posted

      I take an average if 4-5mg per day

      My levels have been good lately, 3.9 today which is perfect. I am glad because i am back at the hospital next week.

      Which hospital are you under?

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    • Posted

      Yes my readings are generally fine - though I was stupid on holiday in LA a month ago and took them 6.30 pm as usual for a couple days then realised the time difference!!! Should have taken them 10.30 am!!! I just carried on as I'd started but my INR was bad when I returned so she saw me the following week. Luckily I get mine done with the nurse at my surgery which is handy!! Such a good idea to get your own machine , that's v frequent testing you have to do. Your readings must fluctuate a lot to have to do them so often.
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    • Posted

      I take mine at 6pm every evening.

      We got a machine when i was about 8 i think. Ive always had to have a test every week (unless the reading is too high or low then its more) so i was missing at least one day at school per week to go to the hospital. My attendence was already poor from having so many surgeries and illnesses and general appointments and we just found it easier because it would mean i could test it then go to school rather than have a day off.

      The machine has been replaced by a newer version about 6 years ago and i bought it because i couldnt imagine having to go to the hospital more than i already do! It also means when im feeling poorly (or if i have had alcohol one evening) i can just test it when i want.

      Once per year i have to take the machine to the hospital and they test my blood on my machine and theirs to make sure the readings are correct and give it a general MOT. Best thing i ever got!

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    • Posted

      Well it sounds like it was a great idea to buy the machine, time saving and so much better for you. I'm sorry you've had such a lot to cope with, you sound like a really wonderful person 😊
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    • Posted

      I took it originally as I was diagnosed with AF around 5 years ago, then after having a cough for 2 years they found it was caused by a leaky heart valve which was repaired over 2 years ago, during the op they tried to cure the AF but it didn't work so have to stay on warfarin 😕 How many surgeries have you had?
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    • Posted

      Wow so they didnt pick it up till you were an adult then?

      I was born with Shones Complex. I had my first surgery at 3 days old. I had 4/5 holes in my heart and repairs to my mitral and aortic valves, and evenutally had them both replaced with mechanical valves. They had the be replaced periodically as my body grew (and obviously they didnt) i also have a leaking aortic valve.

      I have had 12 surgeries so far. I am awaiting my 13th to either replace both valves again or have a heart transplant. At the moment its looking like they are going to replace the valves again because i am not eligable for the transplant list (even though they say a transplant would be less risky now)

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    • Posted

      I feel lucky it was discovered by my lung consultant - the heart consultant treating me for my AF didn't ever listen to my heart with a stethoscope!!! My goodness you have gone through so many operations from so young, and more to come - surely you must be eligable to be on the transplant list?
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    • Posted

      I got AF after my aortic valve replacement four years ago. Cardioversion worked but two other procedures stimulated my vagus nerve and started it up again. Had a pacemaker fitted last year and soon to have an AV Node Ablation.
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    • Posted

      Apparently my "numbers" are too good for a transplant and my lungs are too healthy too. Although i do get very brethless very easily, i can only walk about 5 minutes before i need to rest and if i go shoppung or anything i use a wheelchair because i cant walk for very long. Ive even changed my job because i couldnt stand up allday(i worked in a hotel) so now i work in an office.

      My problem is that because i have had so many surgeries now, my heart has alot of scar tissue. They explained it to me as, they would usually go in and pump a balloon inside the heart to stretch it so that they have room to work and do what they need too, then when they are finished they deflate the balloon so the heart goes back to normal size. However because i have so much scar tissue the balloon wont pump very much because scar tissue doesnt stretch as well, leaving them with not alot of room to work. So effectivly they would be forcing my valves in.

      But if it is successful they believe it should be my last valve replacement as my body has stopped growing now - which would be amazing!

      I am back at the hospital next week so hopefully i will know more.

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    • Posted

      well I guess it's good that your lungs are so healthy but must be awful for you getting breathless quickly and a good thing you work in an office now as I imagine working in a hotel would involve a lot of moving about. 

      It makes sense about the scar tissue and good they explained in such detail as we need to know these things!  such good news that this valve op wouldn't need to be repeated as before because you've now finished growing - these surgeons are just wonderful, I went to Harefield Hospital for my operation which only does heart and lung ops, bit of a distance for my hubby and two kids to visit but they were very good - there were people all ages, (oldest was 95) having valve replacements and I was told its just routine for the surgeons!!!!!  Let me know how you get on next week, will keep fingers crossed you can get things sorted soon.  Thinking of you.

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    • Posted

      I'm surprised that the time difference had so much effect.

      I get my INR checked today and testerday I was five hours late taking my warfarin due to rail travel disruptions.

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    • Posted

      Which procedure would you prefer? While the transplant would stop the need for future surgery you would be on even more drugs. I met a Guy waiting for INR test at our surgery who had a transplant in the early days and is still going strong. When I mentioned him to the nurse she said that they have quite a few transplant patients now.
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    • Posted

      My aortic stenosis was found when I tried to get on the renal denervation trial for hypertension in 2011 and had a thourough examination. In the previous 11 years it had gone unnoticed.

      One patient I met was a retired dancer and had gone through her career with a faulty aortic valve from birth until going to our GP with a cough.

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    • Posted

      Its difficult to say.

      In an ideal world i would just like my valves re replaced again. If they can successfully do that then they say it should be my last time they will be replaced.

      A heart transplant doent nessercerily mean thats your last surgery, some people have to have 2nd heart transplants at a later date.

      I am not keen on a transplant because of he drugs afterwards and the risk of cancer they give you (cancer is a very common in my family already) but they say a transplant would be less of a risk for me.

      At the end of the day, its the surgeons who know best and they are the ones who have to do the work, i just go to sleep and try and keep breathing, they do the hardwork so whatever they suggest is best i will go with. I am going back to hospital next wednesday so i will see what they say then

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    • Posted

      I guess it was because I was taking it 8 or more hours late every day for 10 days and prob it took my body awhile to adjust.  I do often take mine late, even tho I set an alarm on my phone to remind me, I often turn it off but just think 'I'll take them later' and end up around 10 pm!!!  Naughty!!!  I do always keep my 5mg in a pill box on me at all times in case I get stuck overnight somewhere! Thank goodness they eventually found your aortic stenosis, like the dancer you mentioned, they reckoned I'd had my leaky valve from birth - I never would have thought a cough would be a symptom, while waiting for my op (which was cancelled twice) I was up twice a night coughing the fluid up - sorry to be graphic! I think doctors should use stethoscopes more often, why on earth my heart consultant never listened to my heart is a mystery!!!!!  Good old lung doc, I am so grateful to him.  That's a real shame your AF came back after the cardioversion was successful. 
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    • Posted

      Good luck at the hospital next week. The lady who does my annual echocardiogram says that tissue valves are so good now that no one really knows how long they may last and that they are now being fitted to younger patients.

      When I hear of people who had transplants I always think that Tanya the wife of Vinnie Jones has done amazingly well. 

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    • Posted

      Thats good, i have mechanical valves for my aortic and mitral, i always have done. Im nit entirly sure why they didnt try tissue valves with me.

      I will definatly post in here what the hospital say next week!

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    • Posted

      I usually carry a couple with me and people look and wonder what you are taking when you swallow them on a train.

      Strange today my INR had dropped from 2.7 to 1.9

      When first told that I had aortic stenosis a very old memory from 1952 popped into my head. I was having an Army Medical (National Service then) and the doctor who was listening to my chest suddenly looked up and asked if I'd had rheumatic fever as a child. I said No and he grunted and shook his head and again listened intently but did not say anything more. I believe that some people used to eat soap before their medical  as it was supposed to affect their heart rhythm.

      They sent me to hospital for a check up but not for my heart but for my eyes. I think that they thought I was malingering when I said that I could not read any letters on the chart without my glasses.

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    • Posted

      It is amazing how often you must have had your chest opened up.

      I have some sharp bits of wire near the surface that are painful if touched and quite a few bony spurs along the join.

       

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    • Posted

      yes I know what you mean! I often take mine on the tube and get some funny looks!!  That's interesting about your Medical - seems like they could hear some abnormality and wonder why they didn't follow it up.  Made me remember 37 years ago when I was pregnant with my son and nearly at my due date, went for normal check and the doc was ages listening to my heart, kept checking again, and now wonder if he could hear the murmur but again, why didn't he investigate further??? Go figure!!  I too have knobbly bits down my scar where the clips are, apparently you can have these removed but to be honest it doesn't bother me and I can wear a necklace to cover a couple of them!
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    • Posted

      In 2001 when in for an angiogram a student doctor excitedly said that I had a murmur. I presumed at the time that it was nothing serious as there was no follow up.

      When I was in having my valve replaced a day patient was in to have his wire removed but he was the hospital admissions manager so had an advantage. 

      I once dropped a pill bottle on the train with a cop sitting opposite me.

      He picked them up and  studied it before handing it back.

      Two bits of my wire are quite near the surface and as with the knobbly bits I feel them when showering and often when buttoning up my shirt. My wife says what's the matter when I yelp if she rests her arm on my chest when in bed.     

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    • Posted

      yes, that's what the nurse said to me - a murmur. But this means the valve is leaking and I can't understand why they didn't follow this up!  They will remove the wires if you are adamant about it, the lady who was in hospital same time as me had had the same op but only had a very small incision more in the middle of the chest whereas mine goes from high in my chest and she had no knobbly wires, may have been a simpler repair so they didn't need to open her up as much but the ribcage still has to be separated so the surgeon must have been good with his repair job!   Funny the cop picking up your pill bottle!

       

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    • Posted

      I still have a murmur from regurgitation from my mitral valve that the surgeon said was all right for now. I always know during echocardiograms when they get to it. 
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    • Posted

      well its good they say it's ok for now.  Just realised I am overdue for my yearly echo! Mmmm must ring and see what's happening,  have to be proactive or they'll forget me!!!!
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    • Posted

      My hospital sends out next years appoinment right after this years one.

      Do they send you a report on it? The lovely informative lady who does mine does a running commentary for me during it. She said that she would send me a copy of her report but it did not arrive.

      She is really good. Prior to her I had a giant of a Guy who never spoke and pinned me to the table like a wrestler trying for a submission. 

      An interesting girl I had was an Ex Olympic runner. 

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    • Posted

      well that sounds sensible!  much better idea! Will give them a call today anyway to try and get an appointment.  They don't send me a report but generally I am told all is ok at the next appointment.
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    • Posted

      They usually write a lettee to your gp and you should get a copy through the post. If not you can get a copy of your gp usually
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    • Posted

      I once had echocardiograms on consecutive days!

      My local hospital cardiology gave me an appoinment as well as the hospital in Brighton where I had my surgery along with an appointment to see the surgeon.

      Each said they wanted to do their own and their computer systems are separate. Brighton did the scan at the Royal Sussex but the surgeon was not seeing patients there but at Hove Poly Clinic. Guess what ? People at Hove were having echocardiograms done there. They love to make you travel.   

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    • Posted

      ok thanks for that. When I went back for my 6 month check after the op, the consultant just said 'we'll see you in a year' but made no mention of the fact I had the maize procedure during the op to try to correct my AF!! When I mentioned it he looked confused so I just said'oh don't worry, I'll wait till next time'!!!!!!  Which was stupid of me as they were supposed to check in 6 months whether it had worked!!! I seem to get into the 'do as you're told' mode when I get in to see a consultant. Luckily Leatherhead Hospital did the check for me - it didn't work unfortunately.
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    • Posted

      Leatherhead, I used to live near there in New Malden. My wife worked in Maternity at Kingston Hospital.

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    • Posted

      Ah, must have been lovely working in Maternity, all those babies! Hard work though I imagine! 
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    • Posted

      That was something else that changed with the years. From mothers in for about a week to going home the same or next day.

      Usually it was the mothers who demanded more attention than the mothers:-) 

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