Blood Thinners and Alcohol: Everything You Need to Know

1. How dangerous is it to drink alcohol if I'm on a blood thinner?

According to the U.S. Department of Health and Human Services and U.S. Department of Agriculture, moderate drinking is one drink per day for women and up to two drinks per day for men.

There are a number of factors that determine how dangerous moderate alcohol consumption is while taking blood thinners. Unfortunately, these factors are different for everyone.

For the most part, moderate alcohol consumption is safe for people while taking blood thinners as long as you have no major medical problems and are in overall good health. It's important to confirm this with your healthcare provider.

2. What are the risks of drinking alcohol when on my medication?

If you have chronic medical problems associated with either your liver or kidneys, it will affect the metabolism (or break down) of the blood thinner. This may make your blood too thin and put you at higher risk of life-threatening bleeding complications.

Even if you have a normally functioning liver and kidneys, alcohol can limit your liver's ability to metabolize other compounds. It can also limit your kidneys in excreting the broken down toxins or drugs, like your prescribed blood thinner. This can lead to the same harmful effect of excessive anticoagulation.

3. What are some signs I should call a doctor?

Being on any blood thinner will increase your risk of bleeding. Traumatic injuries are one of the most common causes of bleeding, but sometimes you can bleed spontaneously.

Red flag signs include a large amount of visible blood loss in the urine, stool, vomit, or from some physical injury. Seek medical care promptly to stop the bleeding and provide resuscitation as needed.

There are rare circumstances of internal bleeding that may or may not be associated with a traumatic injury. They can be hard to identify and act on since it may not be obvious at first, but injuries to the head are a high risk and should be examined by a healthcare provider.

Other common symptoms of internal bleeding include:

• dizziness
• weakness
• fatigue
• fainting
• abdominal swelling
• altered mental state
• severely low blood pressure (this is a medical emergency, and you must seek medical care immediately)

You also may notice small bruises on your skin appear when little blood vessels get injured from everyday activities. This isn't usually a major concern unless it's extensive or there's marked discoloration.

4. How does alcohol consumption affect my high cholesterol or risk of other cardiovascular issues?

Moderate alcohol consumption has notable and significant health benefits, but not everyone agrees. There are a number of risks associated with any amount of alcohol consumption.

A 2011 meta-analysis that included 84 prior research studies found that alcohol drinkers have a reduced number of cardiovascular and stroke deaths, as well as decreased development of coronary artery disease (CAD) and non-fatal stroke compared with non-drinkers.

The lowest risk of CAD deaths was found in alcohol drinkers consuming approximately one to two alcoholic equivalents. A more neutral effect was found with stroke deaths and non-fatal strokes. This meta-analysis is the foundation of the current alcohol consumption guidelines.

Moderate consumption of alcohol, mainly in red wines, has been found to cause a small increase in your HDL (good) cholesterol.

5. Are some blood thinners different than others in this regard, or is it all the same risk?

There is more than one kind of blood thinner and they work in different pathways within the body.

One of the oldest blood thinners still in widespread use is warfarin (Coumadin). Of all the blood thinners available today, warfarin is more strongly affected by excessive alcohol consumption. However, moderate consumption does not significantly affect the metabolism of warfarin.

Within the last few years, a new class of blood thinners was developed. They offer a number of benefits over warfarin, but they do have some disadvantages. Speak with your healthcare provider about the benefits and risks.

Of these relatively new blood thinners, there are direct thrombin inhibitors, such as dabigatran (Pradaxa), and factor Xa inhibitors, such as rivaroxaban (Xarelto), apixaban (Eliquis), and edoxaban (Savaysa). Their mechanism of action isn't affected by alcohol consumption. It's relatively safe to consume alcohol as long as you are in good overall health and have confirmed with your healthcare provider.

Talk to your healthcare provider to find out which blood thinner you qualify for.

6. Are there tools or resources available to help me reduce my alcohol intake?

Having the restraint to consume only moderate amounts of alcohol may be challenging for some individuals. It's not recommended that you start drinking alcohol if you don't normally.

For those who have a problem with alcoholism, there are resources and tools to help reduce alcohol intake. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) is one of the many institutes of the National Institute of Health (NIH), and is an exceptional resource, consolidating all things related to alcohol.

If you know you are vulnerable to alcohol abuse, don't put yourself in an environment that will tempt excessive intake.

Of course, healthcare providers are here to assist and support you along the way.

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Dr. Harb Harb is a non-invasive cardiologist working within the Northwell Health System in New York, specifically at the North Shore University Hospital, affiliated with Hofstra University. He completed medical school at the University of Iowa Carver College of Medicine in Iowa City, Iowa, internal medicine at the Cleveland Clinic in Cleveland, Ohio, and cardiovascular medicine at Henry Ford Health System in Detroit, Michigan. Dr. Harb moved to New York City, choosing a career path in academic medicine as an assistant professor at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. There, he teaches and works with cardiovascular and medical trainees as well as medical students. He is a Fellow of the American College of Cardiology (FACC) and American board-certified in general cardiology, echocardiography, and stress-testing, and nuclear cardiology. He is a registered physician in vascular interpretation (RPVI). Lastly, he obtained graduate education in public health and business administration to contribute to national healthcare reform research and implementation.