DVT, blood clots and riding on blood thinners

[SlowManiac]

So I always thought my first trip to hospital would be after riding into a tree or getting hit by a car on my commute. What actually happened was that I got a blood clot in my calf which also ended up on my lung.

I was very lucky to catch it early and also it was a pretty minor case. Pulmonary Embolism (PE or clot on the lung) is extremely dangerous - fatal in 30% of cases apparently! :faint2:

I reckon it was caused by a weekend of riding (and getting dehydrated) and then sitting in the car for 5hrs on the way back from Thredbo. Seems this is common amongst endurance athletes - hard exercise - dehydration - being sedentary. Had a bit of calf pain (which I thought was muscular), that went away and then I had pain in my chest which started of fairly minor.

Doctors are a bit confused how I got it - I am 36, fit and healthy, not the usual candidate for DVT

I'm now on anticoagulants for the next 3-6 months - something similar to warfarin but the new generation of drugs. No riding for a month. And - this is where it gets really annoying - I am supposed to avoid any 'high risk' activities while I am on the medication. If I have a genetic predisposition to clotting that could be the rest of my life!

So has anyone else experienced this? Anyone on similar medication (aspirin doesn't count)? How do you manage the risks?

 

[Mywifesirrational]

Doctors are a bit confused how I got it - I am 36, fit and healthy, not the usual candidate for DVT

Yup, you were pretty lucky.

It happens to anyone of any age, it just increases in incidence as we age. I imagine it would have been a mix of things, dehydration results in more viscous blood which in turn is more thrombotic, exertional exercise, particularly high intensity exercise increases blood pressure and this also results in increasing chance of thrombosis. Followed by sedentary activity, long car trip, you now have a DVT. You might be a higher risk than normal due to your genes, but more than likely it's just a combination of factors.

Have you had an ECG done, stress test or symptom limited test done? Well worth seeking a referral if it hasn't already been done as it will rule out any cardiac related problems. If you are in Melbourne I can point you in the right direction for quality guidance on exercise and DVT.

Otherwise, normally general aerobic activity (sub maximal efforts) is normally pretty good for preventing thrombosis, as it promotes fibrinolysis - the prevention or breakdown of clots. Most people I have worked with have no problems with any form of exercise as long as it is moderate, avoid dehydration, take their meds (if they are on them often after 6 months they are clear) and are medically monitored to ensure everything is at the right levels.

Once had a student in a diploma of fitness class being teased by some other meatheads as one arm was 7cm bigger than the other, the skin color was slightly off but their was a pulse (I checked). Asked him if he has seen his GP, which he hadn't, told him it might be wise... thankfully he went that afternoon DVT in his upper arm, spent a week in hospital. I completely missed the symptoms, should have called am ambulance on the spot.

 

[SlowManiac]

I had an ECG in the hospital, nothing mentioned and I'm going back to find out the results.

the bit that worries me is 'moderate' exercise should be OK. In the past I have not really been one for moderation. And being scared that whole time that you are gonna get sick again also sucks...:violin:

 

[big gags]

Slow Maniac,

My wife had a PE about 2 years ago that lodged in her lungs - felt crap for a few days then started breathing really shallow one night and after an ambo ride to hospital they said she had pneumonia but then after she didn't respond to the medication they did some further checks and discovered the PE had lodged in her lungs. We didn't really get briefed by the medical staff in regards to how serious it all was but when one of her friends who was a nurse spoke to us we realised how lucky she was to get through it!! She was on Warfarin for about 12 months and then came off them and is now on an Asprin a day (pretty much for the rest of her life). Since getting off the Warfarin she has gotten back into the gym and pretty much is back to normal apart from the fact that she needs to remember to take a tablet every day.

While she was on Warfarin we stuck to Dr's orders and stayed away from bike riding or any other "high-risk" activity as the advice was to avoid anything that could cause her to bleed out due to her lack of clotting ability.

Good luck with your recovery and I can only recommend listening to your Dr in regards to your recovery plan (by all means seek a 2nd or 3rd opinion but I would recommend against looking for medical advice from the internet).

Gags

 

[JASER]

Hi buddy

I had a Dvt (Factor 5) thanks mom) 15yrs ago,26yrs old(41yrold now) and was fit as a fiddle.
Started in calf and made its way past groin.
Had to stay on back for 10 days and had a nurse inject me in the stomach every day.
I stopped football for a year but got super pissed off,so went to my doctors.
Told him i was missing sport,and he said go play football,but be carefull and if a major injury should occur you will make the surgeon/doctors job bloody hard!!!

Well, carried on till i was about 30 and them started riding off road motorbikes and supermotos,if football wasn't enough of a contact sport
Came off a few times,hit head a few times etc etc.

Moved to Melbourne nearly 5 yrs now and have been pedalling mtb around Lysty every weekend,just push hard,but leave a small % for safety.

I take 10mg every day and drink a few beers a week and just gonna start pushing fitness some more.

Just cause you had a Dvt dont mean you have to wrap yourself in cotton wool and stay in the house,just be sensible.

Go have fun,before your too old buddy.

 

[JTmofo]

Alrite mate,

You are not alone. I was diagnosed with Anti Thrombin 3 deficiency when I was 15 years old after a DVT in my leg (from my calf to my groin) shifted and caused double PE (both lungs).
Its a hereditary disorder that has caused the death of many of my family member throughout the years (but undiagnosed until 1995).

In 2005 I managed to miss some doses of my warfarin, resulting in a double PE again...... which only reassured me that it is crutial to continue the medication when prescribed.

I am now nearly 35, I have been on anti-coags for 20 years. It has had some bearing on my life, but I still manage to get out and do all the things I want to.

It has never stopped me riding, you just have to be smart and protect yourself where you can. There are some things I can't get medical clearance for (diving for example) but I previously raced motorbikes competatively and was cleared by medical doctors.

I would give yourself some time to recover from the DVT, if it was anything like mine, it can cause irrepairable damage to the valve in your veins, causing fluid retention and life long swelling and pain.

if you need any advice or info, feel free to ask.

 

[SlowManiac]

Cheers for all the stories, although it sucks it's good to hear from others that have been through it. I am getting medical advice and I am following it, just wanted to hear from others. Sounds like many of you guys have had more serious clots than mine too and don't let it hold you back.

I have been good, been off the bike for almost 2 weeks now with another 2 to go before I have my first follow up. I have already decided that once I get the clearance to exercise I'll be back on the mtb but will take it easy while I'm on the drugs.

 

[Ridenparadise]

If you are on the new age anticoagulants, the main concern is there is no specific reversing agent if you do have a bleed. That makes head trauma more of a concern than with warfarin. The other issue is that you had a PE and your lung has died in that area. It will take a couple of months to settle down, but you will always lack that full reserve. You cannot push your lung's recovery. You should also have a formal coagulopathy screen. Like a couple of the others on this thread, you may have a factor 5, antithrombin 3, cardiolipin antibody or other similar factor that needs treatment forever. Consult your doctor for the timing of those tests (with regard to your anticoagulants). Hold off on any stress assessment of your heart until your lung has recovered and don't push too hard even with your limbs in case there is any unstable clot still at the site of the DVT. Gentle riding after 6-8 weeks should actually help a bit.

 

[JTmofo]

Cheers for all the stories, although it sucks it's good to hear from others that have been through it. I am getting medical advice and I am following it, just wanted to hear from others. Sounds like many of you guys have had more serious clots than mine too and don't let it hold you back.

I have been good, been off the bike for almost 2 weeks now with another 2 to go before I have my first follow up. I have already decided that once I get the clearance to exercise I'll be back on the mtb but will take it easy while I'm on the drugs.

If i can offer one piece of advice, it would be to get a compression sock for the DVT leg. It will ease the pain and reduce the swelling and will help with getting back doing exercise!

I found that I had a lot of pain and throbbing when up on my feet and using my calf muscle for a couple of months, and these really helped.

This is the brand i used, not attractive to look at, but being a medical compression stocking they offer more compression than the sports compression stocking.

http://www.venosan.com.au/compression-stockings

 

[SlowManiac]

Yeah I'm on one of the new drugs - Rivaroxaban. I'm aware of the lack of reversal agent, but like others have said - you can't live your life in cotton wool. I will certainly take it easy though. I am also going to ask the doctor about timing the dose so that it will be 24hrs since I last took a dose when I head off for a ride.

I was quite lucky that my clots were fairly minor and caught quite early so I am hoping for not much long term/permanent damage. I'm also having the full blood test so I will find out if there are any genetic factors.

I've been wearing a compression stocking but I'm too embarrassed to wear it out with shorts....

 

[macca_newi]

Yeah I'm on one of the new drugs - Rivaroxaban. I'm aware of the lack of reversal agent, but like others have said - you can't live your life in cotton wool. I will certainly take it easy though. I am also going to ask the doctor about timing the dose so that it will be 24hrs since I last took a dose when I head off for a ride.

I was quite lucky that my clots were fairly minor and caught quite early so I am hoping for not much long term/permanent damage. I'm also having the full blood test so I will find out if there are any genetic factors.

I've been wearing a compression stocking but I'm too embarrassed to wear it out with shorts....

Don't stress too much about reversal availability, the treatment for bleeding with both warfarin and rivaroxaban is very similar initially (Plasma or platelets + prothrombinn), warfarin just has the benefit that vitamin k will help reverse warfarins effect (in 2-3 days time), whereas rivaroxaban will mostly be cleared in that time and doesn't have the long lasting effects on the clotting cascade that warfarin does and so doesn't need vitamin K use.

 

[russell1600]

So I always thought my first trip to hospital would be after riding into a tree or getting hit by a car on my commute. What actually happened was that I got a blood clot in my calf which also ended up on my lung.

I was very lucky to catch it early and also it was a pretty minor case. Pulmonary Embolism (PE or clot on the lung) is extremely dangerous - fatal in 30% of cases apparently! :faint2:

I reckon it was caused by a weekend of riding (and getting dehydrated) and then sitting in the car for 5hrs on the way back from Thredbo. Seems this is common amongst endurance athletes - hard exercise - dehydration - being sedentary. Had a bit of calf pain (which I thought was muscular), that went away and then I had pain in my chest which started of fairly minor.

Doctors are a bit confused how I got it - I am 36, fit and healthy, not the usual candidate for DVT

I'm now on anticoagulants for the next 3-6 months - something similar to warfarin but the new generation of drugs. No riding for a month. And - this is where it gets really annoying - I am supposed to avoid any 'high risk' activities while I am on the medication. If I have a genetic predisposition to clotting that could be the rest of my life!

So has anyone else experienced this? Anyone on similar medication (aspirin doesn't count)? How do you manage the risks?

Hey mate,

I'm in a similar boat - rest assured you're not alone!!
On Jan 05th this year I also got a PE at age 38. Doctors also stumped as to the casue as I'm reasonably fit, don't smoke and don't drink (much:madgrin.
Had numerous blood tests all come back clear. Still taking Warfarin at least until July.
Have a look in the Vets forum as there is a thread in there titled 'Riding on Warfarin' with some good advice.
At first my reaction was to pad up everytime I rode to minimise injury/bleeding, but the best advice I read was to wear no pads and ride like you're riding at night and alone. If you pad up you're more likely to push yourself and possibly sustain a more serious injury (ie. internal bleed), which is the real concern. Not the nicks and cuts.
I have been riding XC like normal although the first few times I was pretty nervous. I have even spent half a day DHing in NZ with my young bloke...cautiously.
I hope your results come back clear, and if not - well at least taking the medication is no where near as bad as the alternative...
My doctors mostly said live your life like normal, just be aware...
As others have said, happy to chat more anytime...I was pretty shattered when I got hit with it...

 

[SlowManiac]

Hey,

Good to hear you have gotten back to riding. I am planning my first mtb this weekend after a few few tentative commutes during the week. I am really looking forward to it! yeah I am resigned to being a bit more cautious, lucky I only ride xc and am no crusty demon or anything. As you say there are worse things that can happen I have also accepted what has happened. Hoping that there are no long term effects but at least I can still ride.

My general mood has improved heaps after getting a few rides in this week!

 

[SlowManiac]

Well I've just had my second episode (1st was 3 years ago) of blood clotting. Looks like I might be on medication more long term now as I am obviously predisposed to blood clots. Am on rivaroxaban currently.

I'm signed up for the Haute Route Pyrenees and Alps in 6 months time. This is a bit of a problem as the drugs make me feel a bit spaced out and I need to do a MOUNTAIN of training before now and then. Been told to stay off the bike for 4 weeks.

Plan is it take it really slowly though, I'm not going to be as fit as I planned but I hope I can still do it.

Totally fcuking annoyed!!!

 

[JTmofo]

Well I've just had my second episode (1st was 3 years ago) of blood clotting. Looks like I might be on medication more long term now as I am obviously predisposed to blood clots. Am on rivaroxaban currently.

I'm signed up for the Haute Route Pyrenees and Alps in 6 months time. This is a bit of a problem as the drugs make me feel a bit spaced out and I need to do a MOUNTAIN of training before now and then. Been told to stay off the bike for 4 weeks.

Plan is it take it really slowly though, I'm not going to be as fit as I planned but I hope I can still do it.

Totally fcuking annoyed!!!

That's a pisser. Have you been diagnosed with any particular disorder?
As previously mentioned some years ago, I was diagnosed with anti thrombin III deficiency.
For long term anti coag medication, I've been on old school warfarin. Although it does require a lot of tweaking and testing to get the INR right, there is well established information about the safe use long term.

Did you suffer DVT (leg), Pulmonary embolism etc?

I've have 2 very serious cases of DVT and bilateral PE that nearly ended my life (last being in 2005). Although the after effects can be debilitating, with use of compression wear will limit damage and help with pain and fluid retention.

Even though you have plans for an epic riding holiday etc, having a blood clotting disorder is a serious medical issue. Do yourself a potential life saving favour and do whatever the haematologist tells you.

Good luck, and PM me if you want to chat off side.

 

[SlowManiac]

Ha yes it's fairly annoying to say the least!

I guess I am quite lucky, both my events have been on the minor end of the scale and the second one I was able to catch relatively early as I recognised the symptoms. Both times I had DVT and a PE. I've had the tests but they all came back negative for blood disorders (though they are re-running the tests to be certain).

Yeah I know it's serious and my determination to go ahead may have something to do with the fact that I've already shelled out over 10k hwell:
But rest assured I am going to be speaking to the Docs and won't do anything too stupid.

Thanks for the offer.