Is It Safe to Mix Alcohol and Blood Thinners?


What Are Blood Thinners?

Despite their name, blood thinners don’t thin the blood. Instead, they help blood flow smoothly through the blood vessels, which prevents blood clots that can lead to heart attack and stroke. 

They have often been prescribed for people with the heart condition atrial fibrillation, which causes the heart to beat faster and be more irregular than normal. This condition affects more than one million people in the UK around 7% of those over 65s.

Are All Blood Thinners Anticoagulants?

There are two types of blood thinners: anticoagulants, which slow down your ability to make blood clots, and antiplatelets, which prevent blood cells called platelets from clumping together to form a clot. 

Both of these drugs are considered to be blood thinners.

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What Are the Most Common Blood Thinners?

The most popular blood thinners are aspirin, which can be bought over the counter, and Warfarin, which is prescribed. 

The number of people in the UK taking prescription-only blood thinners will rise dramatically in 2021, as the NHS has agreed to dramatically scale up the number of blood thinners people could be given by 2024. 

However, like any drug, blood thinners come with side effects, especially if mixed with alcohol.

What Type of Blood Thinner Is Aspirin?

Aspirin is an antiplatelet, not an anticoagulant. It works to make your blood less sticky, and so comes under the umbrella term blood thinner. It is estimated that one billion people worldwide take daily aspirin to prevent heart problems. 

Can You Drink Alcohol on Blood-Thinning Medication?

It is advised to do so with caution, and this is for two reasons. Firstly, alcohol is itself a blood thinner and can affect how well blood clots. If you combine it with a medical blood thinner, the effects of both substances can be exacerbated and reduce the blood’s ability to clot. 

Secondly, drinking alcohol can interfere with how medicine works, and blood thinners are no exception. You should always check with your GP about whether it is safe to drink alcohol before taking blood thinners.

If you do drink, you should not exceed the maximum weekly recommended intake of 14 alcohol units a week (a glass of wine is two units and a pint of beer or lager is two or three).

Is It Safe to Mix Aspirin With Alcohol?

In most cases, taking a low dose of aspirin, and drinking responsibly should not be dangerous. However, if you drink too much alcohol with aspirin, it can cause nausea and vomiting, heartburn, stomach ulcers, and gastrointestinal bleeding.

Aspirin can increase the toxicity of alcohol so you might get drunk more quickly, and thus develop alcohol poisoning more easily.

How Does Alcohol Interact With Blood Thinners?

As alcohol is a blood thinner itself, combining it with a medical blood thinner could mean your blood will thin too much, which might make it difficult to clot and this can mean you bleed excessively.

Alcohol can also alter the time it takes for your body to break down your blood-thinning medication which means it can stay in your system for longer. This can affect its efficacy and interfere with your dosage. You don’t want to take another dose if your system hasn’t processed the last dose. 

If you drink more alcohol units than recommended and take blood thinners, you are at risk of haemorrhaging. Always be honest with your doctor about your relationship with alcohol before you start taking any medication.

Warfarin

Warfarin is an anticoagulant that comes in pill or liquid form. It is estimated that at least 1% of the UK population and 8% of people over 80 are taking Warfarin. 

Can You Drink Alcohol With Warfarin?

If you take Warfarin and drink alcohol, your blood can’t clot properly and you can experience major bleeding. For this reason, it’s advised that you limit your alcohol intake to one or two drinks

Xarelto

Otherwise known as rivaroxaban, this anticoagulant comes in tablets and granules and is often prescribed if you have a blood clot in the lung (pulmonary embolism).

Can You Drink Alcohol With Xarelto?

Yes, you can, but heavy drinking or binge drinking will raise your risk of excessive bleeding.

Plavix

Also known as clopidogrel and also sold under the brand name of Grepid, this is an antiplatelet medicine that comes in tablet form. You may be prescribed this with, or instead of, low-dose aspirin.

Can You Drink Alcohol With Plavix?

Yes, in moderation. However, if you drink too much it can irritate your stomach.

Eliquis

Also known as apixaban this anticoagulant, comes in tablet form.

Can You Drink Alcohol With Elquis?

Yes, you can as long as you don’t exceed 14 alcohol units a week. However, if you drink a lot in a short period (i.e. bring drinking), you can exacerbate the effects of Elquis and increase the risk of bleeding.

Blood Thinners

Why Would a Person Be on Blood Thinners?

Blood thinners are prescribed to people who are at a high risk of blood clots, which can lead to heart attack, strokes, mini-strokes (transient ischaemic attacks), deep-vein thrombosis (blood clot on the legs) and pulmonary embolism (blood clot on lungs).

You may also be on blood thinners if you have atrial fibrillation (irregular heartbeat), a mechanical heart valve, or a condition where your blood clots too much (thrombophilia).

Alcohol and Blood Thinners Before Surgery

You may also be given anticoagulants before or after surgery when you may be immobile for a while. 

During this period you may be on painkillers and other medication so it is advised that you do not drink alcohol without seeking medical advice first, and certainly don’t exceed the weekly recommended number of alcohol units. This is because alcohol can interact with any one of these medications.

How Do You Dissolve Blood Clots Naturally?

Your body may naturally dissolve a blood clot over around six months, but in that time the clot can be doing major damage to your health, putting you at risk of stroke or heart attack. For this reason, if you think you have a blood clot, you need to seek immediate advice and a possible prescription of anticoagulants and not wait for it to go away on its own.  

Symptoms of a blood clot include:

  • Pressure, throbbing, cramp, or pain in your leg or arm 
  • Skin changing colour
  • Skin feels warm
  • Swollen, painful veins
  • Sharp pain in the chest 
  • Breathlessness
  • Coughing up blood
  • Blood in your urine 

Blood thinners, whether they are anticoagulants or antiplatelets, don’t dissolve the clot but they can prevent clots from forming and small clots from getting bigger. They do this by helping the blood flow smoothly through the blood vessels. 

What Foods Are Blood Thinners?

Spices such as ginger turmeric, cinnamon, and cayenne pepper have blood-thinning properties as do vitamin K-rich foods such as green leafy vegetables, liver, egg yolks, and mature cheese. However, it is important you keep your diet stable if you are on blood thinners, especially when taking Warfarin. 

Any big changes to your food intake – including ramping up the amount of these blood-thinning foods – can alter the effect of your prescription drug so seek medical advice.  Even herbal supplements such as St John’s Wort, and herbal teas such as chamomile and green tea can interfere with Warfarin.

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When Should You Get Medical Attention?

If you feel you may have a blood clot, especially if you have just had surgery or have been immobile for some time (deep-vein thrombosis is a blood clot in the leg often linked to long-haul flights), you need to seek urgent medical treatment. 

Vomiting blood can be a sign of a clot in the lung and peeing blood can be a sign of a clot in the kidney. Both require urgent attention.

If you are drinking more alcohol units than recommended while taking prescription blood thinners, talk to your doctor. It may be that alongside your need for anticoagulants, you need help to deal with your relationship with alcohol. Even if you don’t consider yourself a heavy drinker, regular alcohol use can impact negatively your blood-thinning medication. 

You may be prescribed blood thinners for decades or even the rest of your life. If you abuse alcohol alongside taking this medication you can raise your risk of stroke, heart attack, or life-threatening clots. Your alcohol use can be just as dangerous as the sticky blood clogging up your veins.

References

  1. Pundi K, Baykaner T, True Hills M, et al, (2021), Blood Thinners for Atrial Fibrillation Stroke Prevention, Circulation Arrhythmia and Electrophysiology: 14 (6)
  2. Pirmohamed M, (2006). Warfarin: Almost 60 Years Old and Still Causing Trouble, Br J Clin Pharmacol: 62 (5), 509-511
  3. NHS England, (2021), Thousands Spared Strokes Thanks to New NHS Drug Agreements
  4. NHS, (2021), About Low-Dose Aspirin
  5. Shen C-J, Kao C-H, Hsu T-Y, et al, (2017), Effect of Alcohol Intoxication on the Risk of Venous Thromboembolism, Medicine (Baltimore): 96 (42)
  6. NHS, (2021), Common Questions About Low-Dose Aspirin
  7. Gentry R T, Baraona E, Amir I, et al, (1999), Mechanism of the Aspirin-
    Induced Rise in Blood Alcohol Levels, Life Sci: 65 (23) 2505-12
  8. Piano M R, Alcohol’s Effect on the Cardiovascular System, Alcohol Research Current Reviews: p 219-241
  9. Efird L M, Miller D R, Ash A S, et al, (2013), Identifying the Risks of Anticoagulation in Patients with Substance Abuse, J Gen Intern Med: 28 (10) 
  10. Roth J A, Bradley K, Thummel K E, et al, (2015), Alcohol Misuse, Genetics, and Major Bleeding in Warfarin Therapy Patients in a Community Setting, Pharmacoepidemiol Drug Saf
  11. NHS, (2022), About Rivaroxaban
  12. NHS, (2021), Clopidogrel
  13. NHS, (2022), About Apixaban
  14. NHS, (2021), Uses: Anticoagulant Medicines
  15. National Blood Clot Alliance, Stop the Clot, Managing Anticoagulants Before, During, and After Medical Procedures
  16. NHS, (2021), Blood Clots
  17. NHS, (2022), Advice About Food and Drink
  18. Tan C S S , Lee S W H, (2020), Warfarin and Food, Herbal or Dietary Supplement Interactions: a Dietary Review, British Journal of Clinical Pharmacology
  19. Madden M, Morris S, Stewart D, et al, (2019), Conceptualising Alcohol Consumption in Relation to Long-Term Health Conditions: Exploring Risk in Interviewee Accounts of Drinking and Taking Medications, PLOS One

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