Riding on Warfarin

Kojarena

Likes Bikes
I had some varicose veins out of my right leg back in November last year. About two weeks later, during recover, I developed DVT in the same leg and a week later that progressed to a bilateral pulmonary embolism - 66% blockage of both lungs from clots.

After eight days in hospital I ended up on Warfarin. Doctor reckons six months on the meds plus wearing a pressure stocking and then, depending on my lungs I should be okay to go off the drugs.

Last week I rode the Mt Annan intermediate course and later that week did a 16km brisk walk. On Good Friday I had some breathing difficulty and pain in the chest.

Ended up in hospital yesterday and the day before - had all the tests again (DVT scan, CAT scans, INR, coronary, sugars, blood gases (I hate that one the most) and the diagnosis is that I didnt have another PE, it wasnt a stroke or a heart attack.

They reckon it is a muscle strain across my chest causing pain and shortness of breath (each time my chest expands it hurts). I am 41 and in reasonable health, dont smoke, drink, I eat mainly a vege based diet, dont do drugs etc.

So the doctor is asking me what I did to stress the muscles and I told him. Two hours later he comes back with the rest of the vascular team and tells me I am NOT to ride a bike whilst I am on warfarin because if I come off and sustain an internal bleed it will not stop and I will eventually bleed to death - either a bleed on the brain or in the abdomen will be pretty bad. Also riding and coming off can cause clots to dislodge.

THe good news is that almost all the clots in my right leg are gone, as are the ones in my lungs so I am very likely to come off Warfarin next month.

So is anyone else here on warfarin, coumadin or other blood thinners and do you ride? What do you think of the risk.

They said I can ride on a trainer, walk, run, swim, gym etc but no contact sports or activities where I could sustain a fall or impact.

What gives?
t
 

JASER

Likes Dirt
I'm 38 and been on 10 mg warfarin for 11yrs now
I'm missing factor 5 in my blood!
I stopped playing football in uk when it first happened but went back to my docs and said I need to play again.
He said go live ya life n just be careful!
Well played on for another few years to then race Supermoto bikes and ride offroad bikes and do plenty track days on bikes,head butted aka highsided a few times too.
Just be careful and your be reet.
My bro whoses 40 just got diagnosed too(thanks mom) n he rides roadies 150 miles a week!
Best advice I can give "tuck n roll"
Jase
 

Australia

Likes Bikes and Dirt
I had some varicose veins out of my right leg back in November last year. About two weeks later, during recover, I developed DVT in the same leg and a week later that progressed to a bilateral pulmonary embolism - 66% blockage of both lungs from clots.

After eight days in hospital I ended up on Warfarin. Doctor reckons six months on the meds plus wearing a pressure stocking and then, depending on my lungs I should be okay to go off the drugs.

Last week I rode the Mt Annan intermediate course and later that week did a 16km brisk walk. On Good Friday I had some breathing difficulty and pain in the chest.

Ended up in hospital yesterday and the day before - had all the tests again (DVT scan, CAT scans, INR, coronary, sugars, blood gases (I hate that one the most) and the diagnosis is that I didnt have another PE, it wasnt a stroke or a heart attack.

They reckon it is a muscle strain across my chest causing pain and shortness of breath (each time my chest expands it hurts). I am 41 and in reasonable health, dont smoke, drink, I eat mainly a vege based diet, dont do drugs etc.

So the doctor is asking me what I did to stress the muscles and I told him. Two hours later he comes back with the rest of the vascular team and tells me I am NOT to ride a bike whilst I am on warfarin because if I come off and sustain an internal bleed it will not stop and I will eventually bleed to death - either a bleed on the brain or in the abdomen will be pretty bad. Also riding and coming off can cause clots to dislodge.

THe good news is that almost all the clots in my right leg are gone, as are the ones in my lungs so I am very likely to come off Warfarin next month.

So is anyone else here on warfarin, coumadin or other blood thinners and do you ride? What do you think of the risk.

They said I can ride on a trainer, walk, run, swim, gym etc but no contact sports or activities where I could sustain a fall or impact.

What gives?
t
What INR are you targetting?
 
Wafarin

I work as a Nurse.

For your information:

Warfarin is stopped 5 days before surgery.

'Bleeding time' (INR) needs to be below 1.5 before surgery.
 

safire

Likes Dirt
My boyfriend also takes warfarin (he has a prosthetic heart valve) and will for the rest of his life (been a few years now). His doctor wasn't quite so conservative with regards to riding and mtb in particular. The doc said to be careful and basically not to go jumping off any big rocks! Dave didn't ask him what he considered big though...

Since being on the rat poison, Dave has had plenty of little crashes on the mtb and normally wears elbow and knee pads while riding (even xc). When doing anything of the dh variety its full armour from head to toe every time and b lines around any big jumps and drops. As well as the little mtb crashes he has also hit a tree snowboarding (broke 2 ribs) and been hit by a car on the commute (few stitches and grazes and bruises). He gets a bit more bruised than usual but not as bruised as I get for the same little crashes. The only time I have seen him bruise up more than me is when his INR is too high and getting up around/above 3. His target range is 2 - 2.5.

Seems to me that small crashes are not the problem, you really don't want to have a big one though. If you do have a big one then get yourself to the nearest hospital asap, regardless of how you think you feel when you pick yourself up off the ground. Guess its each to their own as to how much risk you want to take.

Dave would rather take a risk and be extra careful about it rather than wrap himself up in cottonwool and stay indoors. If he wasn't able to ride his bikes or his moto (road + track days) then for him that's not really living.

Anyway, goodluck with your clots disappearing and getting off the warfarin.
 
Warfarin and riding

Hi, I had a Pulmonary Embolism at the Mont in 2009, probably caused by a DVT. Subsequently I am now on Warfarin for life (2-3 range INR). I was off the bike for about a year and I don't think I will compete in shortcourse XC races again. I have done a couple of 50k races (Husky and DW) and I am building up to doing 100k races (rides) again soon. The thing is to manage your risks, for me the shortcourse races like 4,8,24hr races, where there is a large range of riders of different abilities trying to pass and doing silly things is just too risky. The chances of being knocked off are too high. Marathon style races are slightly different, there are usually more overtaking oppotunities, less aggro and generally fewer people trying to pass. I have considered doing the Mont again because it is also generally less aggressive and a less technical course than say Stromlo. I am also buying myself some knee and elbow guards (been looking at 661 Evo Lite XC).

I also ride a road bike, again you need to manage the risks. I only ride when I can find someone to ride with - I never ride alone. I always carry a good first aid kit (with lots of bandages) when I am riding off and on road. For road rides I choose my routes very carefully avoiding busy roads and I only ride very early in the morning on weekends when there is less traffic on the road. I also ride in a local National Park which is locked out to cars before 9:00am.

If you can, ride with someone trained in first aid.

I wear a Medi-Alert bracelet, this tells emergency personnel that you are on medication and they can then take that into consideration when they are treating you.

Goodluck with your recovery, don't push yourself too hard, from my experience it is a long slow road. Keep riding but do it carefully.

Kave-man
 

Wednesday

Likes Dirt
As all said above ^ all hemostatic problems associated with a serious open wounds become the issue with the warf peeps in terms of platelet aggregation. As part of mature minded adults, dvt's, pe's, post AMI etc can be managed through exercise as part of your rehabilitation both now and for many years to come.
I would consider investing in some decent mtb clothing, protective elbow/knee guards, good gloves and undergarments that minimise this potential, ride with someone at all times on clearly marked trails, med alert, mob phone ICE as mentioned ^ ^ ^ and give up aspirin etc etc.
Ive been fighting Hodgkins Lymphoma for the last few years and while im not on Warf or suffer your illness, all blood problems associated with open wounds/infections/medications/clots (or for me smashed blood counts) etc are difficult to manage if your not carefull with your riding and overall health.
Just listen to your body and dont give up!
 

pharmaboy

Eats Squid
hi, firstly, the doctor is covering his arse legally - you have given him info on a risky activity (in his eyes) and he has given you advice that will make his mediacl indemnity company happy.

Now, as to minimzing risk - i dont think that superficial cuts and abrasions consitutue any significant risk unless you are 100miles from help - therefore body armour / protection confers no advantage. Quite the contrary, I believe its more likely you will ride more aggressively suitably protected, and thus heighten your risk of a serious prang that does have internal bleeding risk - eg your chances of surviving a spleen bleed may be far slimmer than me.

So, wear short sleeves and no gloves, treat it like night and you are alone, and your attitude will change to risk and you will ride slower and truer - any unknown trails are taken far more carefully as well. i know this sounds counterintuitive, but its behaviour that is most likely to cause risk, not the level of protection. ie everyday is a social ride - smash it up the hills but not down. ;)
 

Red Peekay

Likes Dirt
Agree with the above OP. If you still feel a bit concerned about injury then go for the armour. I wear knee/shin pads and elbow pads everytime I get on the mtb, whether I'm all mountain or XC. I've got dodgy knees and just can't afford time off due to injury (that being said, all the armour in the world didn't help when I landed on my head.... off to hospital and a 3 month stint in the spinal ward). It all comes down to your 'risk appetite', what are you prepared to live with?? Good luck.
 

Australia

Likes Bikes and Dirt
I'm not suggesting you follow my example (in fact, you probably shouldn't, if following my example doesnt kill you, your doctor will), but I'm going to try and put a little perspective on this.

On account of a prosthetic heart valve I am on warfarin and target an INR of 2-3.

My first big suggestion (actually, screw suggestion, this is an order) get your hands on a Roche Coagucheck (or equivilant). Its a little finger prick INR tester exactly like diabetics use. I dont wait two days for my INR test results, I get them instantaneously, and make a point of testing the night before any big ride. Don't ride if you are above 3.5. Just dont do it.

Now I know all that sounds sensible (and it is) now I am going to set a horrible example.

Despite the blood thinners I ride 24 hour Solos, Team 24s, XCMs, Shorter Enduros, and rare XCO races. I've ridden DH in Australia and Canada whilst wearing nothing more than a Fullface, Shin Pads and Gloves. I got airlifted out of Whistler after a stack in the Whistler bike park which broke 3 ribs in 5 places, nearly crushed my pancreas, and landed me in a precautionary neck brace and 3 day stay in hospital (while I had an INR of 3.2 - I forgot to check it the night before) I even ride my road bike alone on major roads.

That said, I gave up abseiling and Rugby on the doctors orders.

If you have an absolutely draconian doctor who is ruling out every inch of fun in your life, get a second opinion. Don't let them scare the crap out of you, you're not going to spontaneously bleed out every time you have a trip over the bars. Odds are you'll bruise up slightly bigger than the guy next to you, and the trickle of blood down your shins will be a little longer - but I feel confident in saying (from personal experiance) the risk is overstated.

That said, I'm only 20, maybe I bounce better than you Vets :p
 

pinkbike

Likes Dirt
The big risk on warfarin is internal and particularly intracranial bleeding, a bit of bark of the knees is not going to kill you - will make a mess tho!

The medical profession is somewhat indoctrinated to keep people alive, however not every doctor has mastered the balance between keeping people alive and allowing people to have a life. In reality that's because it's not their choice, it's yours. Your doctor shouldn't be telling you what to do and not to do, but they should be clearly explaining the risks and benefits of your intended activities.

The best bit of advice I can give you is find a good GP, that means a GP who understands what makes you tick. If you're not the type who generally gets sick, doesn't matter still find a good GP and make a point of seeing them once a year or so. Then when crap like this happens you can head for the GP with your discharge letter and say "right now that doc in hospital said not to ride, what are my options". Thing is the doc in hospital is a) probably junior(ish) b) doesn't know you c) probably figures it's easier to rule out riding rather than go through the pros and cons d) got told off by his superior for even asking about riding and got made to feel stupid.... a good GP can sift through the info from hospital and relate it to you, if they know you.

I like Straya's finger prick INR tester - but they ain't cheap and if your warfarin is short term it could be a decent $$ outlay. Worth checking out if private health insurance will cover the cost.

Warfarin can be reversed in hospital, so access and time to medical care is something to consider when riding. MediAlert - definitely!
 

Australia

Likes Bikes and Dirt
The big risk on warfarin is internal and particularly intracranial bleeding, a bit of bark of the knees is not going to kill you - will make a mess tho!

find a good GP, that means a GP who understands what makes you tick.

INR tester - Worth checking out if private health insurance will cover the cost.

Warfarin can be reversed in hospital, so access and time to medical care is something to consider when riding.

MediAlert - definitely!
Good points.

Be prepared to throw a shoulder/arm/leg/whatever in front of you as you fall. Collar bones and ribs arent going to make you bleed out - your head will

My GP isn't a cyclist but does run ultra marathons - she ended up helping me with my race nutrition plan

My private health cover chipped in some money for the tester, but I wouldve paid full retail

MEDI-ALERT can't believe I forgot it. Also makes you look like a Giro/Tour rider when you are out of the saddle climbing with your jersey unzipped! Gotta love bling.
 

Slowman

Likes Dirt
I was on warfarin for 6 months while I was on crutches, at that time my biggest worry was falling over and braking my leg again. I was going crazy sitting inside all day so I had to get out,,,nothing too strenuous or risky I rode bike paths but it was so good for my morale.

As numerous people have said it is about risk management. I was never going to be on warfarin longer than I was immobilised and posed a clot risk, so for me it was easy to just stick to low risk rides as it would only be temporary. What I am trying to say is don't take risks you don't need to if this is only temporary.

I am in a similar situation again after just having had a BHR (Birmingham Hip Resurfacing). I am not to do anything "extreme" for 6 months which is the time taken for the bone to really strengthen around the prosthetic stainless steel inserts. For the first 6 weeks there is a risk of dislocation and dislodgment of the prostheses if I have a fall. So for that 6 weeks I am not even thinking about riding, such a short period of time it would be stupid to take any risks.

It is from about 6 weeks to 6 months where I will just do very low risk rides and even see if I can focus more on long walks to also reduce risk.

I take risks in life but not unnecesary ones - I hope you find that approach useful.
 

Fat Chilli

Likes Bikes
Good read,

I was the recipient of DVT due to flying back from Portugal on 24 Aug 2008, upon arrival and knowing DVT's symptoms (swollen right leg etc.) I took myself straight to the GC Hospitals A&E, they did the usual checks for DVT - i.e. ECG and a shot of clexane. I was told that they couldn't perform and ultrasound at the time and would need my GP to refer me for one in the next day or two; this I did.

Had the ultrasound, nothing showed up; so I went about my business as normal. On 1 Sep 08 I call my Dr and advised him of the pain in my right leg, he advised me that nothing showed up in the ultrasound, so it must be muscular.....carried on with my business and did as the Dr suggested and took some Ibuprofen. On the 3rd of Sep 08 I called the Dr, this time the pain in my right leg was excruciating and not allowing me to sleep! The Dr advised me to stick with the Ibuprofen.

On the morning of the 4th of Sep 08 I was getting ready for work, the wife had already left. I took the Ibuprofen and felt nauseous, I remember standing over the toilet as if to spew..... Then some time later I came too on the floor, found myself laying in a massive pool of sweat and drool, crawled to the bed from the en-suite and grabbed the phone, thought I'd had a heart attack! Call the ambulance and waited.
Call my wife and work, they all called for ambulances too, so I had two ambulances show up, one of the para-medics was trying to tell me that their was a bug going around making people feel this way......Having been a paratrooper in a past (Green) life and having completed a Patrol Medics course I was not that stupid!

Got to the hospital, did all the tests and had a 3 week stay in cardio ward and then respiratory wards, was diagnosed with MPE (Massive Pulmonary Embolism) and after wards the two specialist working on me advised me that they would have given me half a day to life (scary shit!). I had half of my right lung filled with blood and a total of one third of my lung capacity filled as well as strain damage to the right aorta of my ticker.

Mid way through my stay in hospital i was poked in the chest by a nurse and went into respiratory shock (code blue was called), she had caused me to have an infarct - could have killed me on the spot.

After this i was placed on Warfarin for 6 months.

Six months after the cessation of Warfarin I was back on it, this time due to a long drive, the original clot probably never fully vanished? I recognised the symptoms early and took myself back into hospital for a 2 week stay. Had 3 PE's on my lungs. So now I'm on Rat Sack for the rest of my life. The original Dr no longer gets my $$$ after his errors, both specialists advised me that the GP should have referred me back for a second ultrasound within the initial week for follow up, this didn't happen and the clot was missed.

Currently on 10.5mgs and looking into the coagucheck devise, hate the crap! I sought advise from a third specialist who advised I also give up DH/Free-riding, and anything that required the wearing of a full face helmet. So the bike has not been used for anything other than towing the kids around in their trailer in recent years.

Anyhoo - good to find out I am not the only one in this predicament. Been contemplating the idea of a CC bike to play it safer.
 
Last edited:

Australia

Likes Bikes and Dirt
Good read,

I was the recipient of DVT due to flying back from Portugal on 24 Aug 2008, upon arrival and knowing DVT's symptoms (swollen right leg etc.) I took myself straight to the GC Hospitals A&E, they did the usual checks for DVT - i.e. ECG and a shot of clexane. I was told that they couldn't perform and ultrasound at the time and would need my GP to refer me for one in the next day or two; this I did.

Had the ultrasound, nothing showed up; so I went about my business as normal. On 1 Sep 08 I call my Dr and advised him of the pain in my right leg, he advised me that nothing showed up in the ultrasound, so it must be muscular.....carried on with my business and did as the Dr suggested and took some Ibuprofen. On the 3rd of Sep 08 I called the Dr, this time the pain in my right leg was excruciating and not allowing me to sleep! The Dr advised me to stick with the Ibuprofen.

On the morning of the 4th of Sep 08 I was getting ready for work, the wife had already left. I took the Ibuprofen and felt nauseous, I remember standing over the toilet as if to spew..... Then some time later I came too on the floor, found myself laying in a massive pool of sweat and drool, crawled to the bed from the en-suite and grabbed the phone, thought I'd had a heart attack! Call the ambulance and waited.
Call my wife and work, they all called for ambulances too, so I had two ambulances show up, one of the para-medics was trying to tell me that their was a bug going around making people feel this way......Having been a paratrooper in a past (Green) life and having completed a Patrol Medics course I was not that stupid!

Got to the hospital, did all the tests and had a 3 week stay in cardio ward and then respiratory wards, was diagnosed with MPE (Massive Pulmonary Embolism) and after wards the two specialist working on me advised me that they would have given me half a day to life (scary shit!). I had half of my right lung filled with blood and a total of one third of my lung capacity filled as well as strain damage to the right aorta of my ticker.

Mid way through my stay in hospital i was poked in the chest by a nurse and went into respiratory shock (code blue was called), she had caused me to have an infarct - could have killed me on the spot.

After this i was placed on Warfarin for 6 months.

Six months after the cessation of Warfarin I was back on it, this time due to a long drive, the original clot probably never fully vanished? I recognised the symptoms early and took myself back into hospital for a 2 week stay. Had 3 PE's on my lungs. So now I'm on Rat Sack for the rest of my life. The original Dr no longer gets my $$$ after his errors, both specialists advised me that the GP should have referred me back for a second ultrasound within the initial week for follow up, this didn't happen and the clot was missed.

Currently on 10.5mgs and looking into the coagucheck devise, hate the crap! I sought advise from a third specialist who advised I also give up DH/Free-riding, and anything that required the wearing of a full face helmet. So the bike has not been used for anything other than towing the kids around in their trailer in recent years.

Anyhoo - good to find out I am not the only one in this predicament. Been contemplating the idea of a CC bike to play it safer.
10.5mgs!!! what INR have your doctors got you at?
 

Fat Chilli

Likes Bikes
10.5mgs!!! what INR have your doctors got you at?
Trying to keep me around the 2.3 - 2.5 mark; was on 11mgs up until 3 months ago.

Anyone know anything more about the new wonder drug to replace Warfarin, heard from my pharmacist today that the pharmaceutical company releasing it was to have a presentation session to specialists and GP's this weekend up on Tamborine Mt at one of the wineries but it got canned due to the Therapeutic Goods Administration (TGA) not approving it in time for the scheduled release.

Not sure if the drug is Dabigatran (Pradaxa) - http://www.pharmacynews.com.au/news/warfarin-replacement-wins-approval-for-stroke-prev or something else, but apparently whatever it is, it is self dosing / regulating(?)
 
Before I started on Warfarin I took part in a clinical trial of a blood thinner - Rivaroxaban. The good thing about it was that you just take one tablet a day (20mg from memory) and didn't need regular blood tests. Negatives are that the drugs effects are not reversible unlike Warfarin (from my understanding - I'm not a Dr). If you do have an accident and a major bleed, an injection of vitamin K will reverse the blood thinning effect of Warfarin. Taking a non reversible blood thinner is a fairly concerning prospect. I have not heard if this drug has been approved by the TGA, but they were hoping it would be fairly soon. The main treatment they were wanting to use it for was post operative prevention of clots and DVT's in knee and hip replacement patients. Other negative effects I found were dizzyness, heart palpitations and anxiety. But these symptoms could have been as a result of my pulmonary embolism???
 

UncleFeet

Likes Dirt
...was on Warfarin (around 3mg as I remember) after shocking thrombophlebitis and removal of an AV fistula in left arm...symptoms started right after a 4 hour ride about a year ago...going from slight pain to having my forearm looking like my thigh...for a little while limb loss was on the cards but thankfully I'm all still here...

I kept riding on warfarin. I regularly scratch and knock skin off. The bleeding took about twice the time to stop while on Warfarin...
 

Australia

Likes Bikes and Dirt
11mgs to get to 2.3-2.5. You must eat a kilo of lettuce a day or be 10 feet tall!

6mg keeps me smack on 2.5 with 3 serves of vitamin k containing vegetables a day.

This new irreversable self-regulating drug intrigues me. Its probably not a problem that it is irreversible provided it self regulates very precisely (a major bleed with an INR of precisely 2.0 is only marginally more scary than an ordinary persons major bleed. INR is a logarithmic function so it ramps up quickly - i.e. 4.0 is about 8 times as thin as 2.0 etc.)

The self regulating thing is quite appealing because it means that the finger-pricks can stop. I'm generally pretty reliable, but occaisionally go 1.5 weeks without checking it and find that although I haven't lowered my vitamin k intake its jumped up to 3.8 without me noticing.
 
Top