Sunday Brunch with Champagne

On Thursday August 23, 2018, the Lancet published a study co-authored by 512 researchers from 243 institutions.  The goal was to estimate how alcohol affects the risk of 23 health problems.  The researchers found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimizes health loss is zero.  This level is in conflict with most health guidelines, which espouse health benefits associated with consuming up to two drinks per day. Alcohol use contributes to health loss from many causes and exacts its toll across the lifespan, particularly among men.  The harmful effects of any alcohol consumption greatly outweigh any potential benefits. (http://bit.ly/washpostetoh, http://bit.ly/lancetfulltext)

I was planning a champagne brunch menu for some friends when I saw this new study in the Lancet.  It made me think of a very common question from patients about the safety of drinking alcohol before and after surgery.  In my practice, in general, we recommend that patients limit alcohol intake for overall health and wellness.  We emphasize this now more than ever given the newest research emerging that shows that ANY alcohol intake causes more risk than benefit.  Specifically, around surgery, we recommend that patients completely abstain from drinking any alcohol at least 1 week before and 1 week after surgery.  

Studies have shown that high and low concentrations of alcohol disrupt normal platelet function, specifically the ability to aggregate and form clots.  Normal platelet function is required for blood clotting; abnormal platelet activity can increase bleeding and the risk of hematoma (blood collection under the skin) after surgery.  Red wines, in particular, have rich anti-platelet activity from both the ethanol and polyphenolic components.  Several studies carried out on humans and animals have shown that wine phenolics could exert their effects by reducing prostanoid synthesis from arachidonate. In addition, it has been suggested that wine phenolics could reduce platelet activity mediated by nitric oxide. Moreover, wine phenolics increase vitamin E levels (vitamin E also thins out the blood) while decreasing the oxidation of platelets submitted to oxidative stress.  It takes about 1 week for the body to create normal functioning platelets – hence the 1 week of no alcohol use before and after surgery. 

A rebound phenomenon of hyperaggregability (hyper-clot-ability) is observed after an acute alcohol consumption which is not observed with wine consumption.  The rebound phenomenon may explain ischemic strokes or sudden deaths known to occur after episodes of drunkenness.  This is another reason why alcohol intake close to the time of surgery is not safe.   

In conclusion, the adage that 1-2 glasses of red wine per night has a protective effect on the cardiovascular system may no longer be accurate.  Without question, alcohol consumption of any kind is not safe around the time of surgery due to the disruption of the platelet’s ability to form blood clots.  For the safest surgery and the quickest recovery, we recommend that patients avoid alcohol completely for at least 1 week before and after surgery.  For the highest level of health and wellness, regular intake of alcohol should be avoided. 

Ruf JC. Alcohol, wine and platelet function. Biol Res. 2004;37(2):209-15.

Miceli M, Alberti L, Bennardini F, Di Simplicio P, Seghieri G, Rao GH, Franconi F. Effect of low doses of ethanol on platelet function in long-life abstainers and moderate-wine drinkers. Life Sci. 2003 Aug 8;73(12):1557-66.

Zhang QH, Das K, Siddiqui S, Myers AK. Effects of acute, moderate ethanol consumption on human platelet aggregation in platelet-rich plasma and whole blood. Alcohol Clin Exp Res. 2000 Apr;24(4):528-34.

 

Author
Kaete Archer, MD Facial Plastic Surgeon

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