Question Title: coumadin and alcohol

My husband has Marfan's syndrome, and had his aortic valve and arch
replaced (both are artificial/mechanical) about five years ago due to
an aortic disection. He is 23 years old now. He was put on coumadin,
3 mg per day, and also atenelol 100 mg per day. He recovered well and
hasn't had any problems since.

My question has to do with alcohol consumption. Is it bad for someone
with Marfan's to drink? Or for someone taking his medications? He has
a drink now and then, not a lot, but when I've asked him about it he says
it's fine as long he doesn't get hurt (since the blood would clot more
slowly on coumadin, and even more slowly with alcohol in the system). Am I
being paranoid here? I want him to enjoy himself, and truthfully nothing
bad has ever resulted from him having a drink now and then. He says his
doctor OK'd it as long it was moderate, but I still worry. Also, if
alcohol increases the effect of coumadin, how much does it increase it by,
and for how long? Is it really OK as long he's just careful not to injure
himself? And how much alcohol is "moderate"? This has been bothering me
for a while now, so any input would be appreciated.

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Dear Cathy, thank you for your question. Alcohol can interact with coumadin through it's metabolism in the liver. Alcohol is degraded by enzymes in the liver. Clotting factors are also made in the liver so coumadin exerts its effect in the liver. Certain clotting factors depend on vitamin K to be produced. Coumadin inhibits vitamin K to cause the blood the be "thinned." When execesive alcohol is consumed, the liver is "preoccupied" with degrading the alcohol and may actually be damaged by the alcohol. When this occurs, the effect of vitamin K is magnified so the blood can be over anticoagulated. It's difficult to say how long this effect lasts since the metabolism of alcohol and coumadin is highly variable in different patients. Also, since alcohol can impair the senses and put patients at a higher risk of falling or having an accident, the risk of bleeding while on coumadin and alcoholo can be increased. Typically, I advise patients taking coumadin to have no more than one drink per day (12 oz. beer, 4 oz. wine, 1 ox. hard liquor) which would be considered "moderate" and should not cause any problems. Certainly, more than 2-3 drinks/day would be considered excessive when someone is taking coumadin. I think your husband should do fine with moderate alcohol consumption but only his physician can determine what is "moderate" consumption in his case. Alcohol consumption does not affect the disease process of Marfan's syndrome I hope you find this information useful.

Information provided in the heart forum is for general purposes only. Specific diagnoses and therapies can only be provided by your physician.

~Cathy

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