Blood thinners

[fatbob]

Asking for a family member

I know the standard medical advice re anti coagulants avoid activities which may need to cuts, bruising or head injuries so skiing is under conservative advice not recommended.

However there is also the issue of quality of life if someone is potentially going to on the medication for an extended or even lifelong period - long time to go without riding a bike, taking a hike on rough ground or mountains or skiing. Think it's clealry logical to avoid sports like hockey, rugby etc. Any experiences of managing? Anti-coag in this case is Eliquis (apixaban).

Major concern I guess is cranial bleeds which make things like concussions higher orders of severity. Plus modern anti-coags seem less easily reversible than a shot of Vit K on the old rat poison.

 

[Fishbowl]

It’s not the daily activity of skiing which is dangerous on a thinner, which is why so many people will tell you they have skied for years without issue, but the random traumatic injury that can rapidly become serious or life threatening, which is why most Drs will not recommend it. Imagine losing your leg over a torn ACL, or stroking out from a mild concussion?

It’s all risk and reward, just with really high stakes.

 

[Fuller]

I've been on Brillinta (plus 81mg aspirin) since my stent was put in 16 months ago. They started me with 90mg twice per day that made me bleed like crazy from every little scratch. The bruising on my forearms was continuous. Lately I was able to scale back to 60 mg x2 daily which is a bit more manageable.

I have to admit I have given very little consideration to the added risk of bleeding out on the slopes compared to how my heart was doing. I was so happy to be skiing 7 months after dropping (almost) dead I didn't worry about much.

Realistically you're not going to stop skiing - just make your skiing partner aware of the issue so they can pass it on to Patrol if need be.

 

[John Webb]

I'm going to visit the doc in 2 weeks. will demand getting off anti--coagulants as the problem triggering it only occurred once
4 years ago. Cardiologist even wonders why I visit as he has never found any problem.

 

[Grizzly777]

I used to have thin blood and couldn't even take a fish oil vitamin or aspirin without excessive nose bleeds for a few days. It seems my blood has turned to paste it seems over the last 10 years. I now have a history of clots and have been having good luck with taking natural Nattokinase daily from health food store. I've been on prescription blood thinners Xarelto being the worst in past and hated the nasty side effects plus risk of bumping your head is not worth it to me. With Nattokinase I have had no side effects and it has done its job for the past 2.5 years clot free and improved blood flow. I found out about it from homepathic doctor.

 

[toddmanley]

Xarelto being the worst in past and hated the nasty side effects plus risk of bumping your head is not worth it to me. With Nattokinase I have had no side effects and it has done its job for the past 2.5 years clot free and improved blood flow. I found out about it from homepathic doctor.

I'd love to learn more about your switch from Xarelto to Nattokinase. I've been on thinners (Xarelto for the past 5 years) since 2004 and looking for a better alternative.

-Thanks, Todd

 

[crgildart]

I'm not a doctor and didn't stay at Holiday In Express either.

Just eat a big bowl of collard greens the day before you go skiing and get right back on your anti coag après ski?? Odds of clotting are low unless you have a long drive or flight to deal with where you have to sit still for hours and hours..

Wife's a clotter and takes warfarin to prevent another brain tumor. We have our own INR meter and test strips. Twice she has gotten bad batches of warfarin and had the INR shoot off the chart at 10 with 10 being the highest it goes.. Bruising and bleeding is the sign it's high as mentioned. I feed her a couple servings of high vitamin K collards and the INR is back down in less than two days.

That said, wife doesn't ski or do anything at all with significant risk of a fall. If she already knew how to ski and ski well she'd probably do it and take it easy. With a much greater risk of falling while learning, it isn't worth it since she will definitely fall learning. She'll ride a bike around the block though since she already feels comfortable and not afraid of falling there.

 

[Beartown]

There's a lot of BS being thrown around on this thread by people who do not appear to understand what they are talking about. First and foremost, I would definitely not recommend getting any medical advice from an anonymous internet board. There are any number of reasons people are on anticoagulants/platelet inhibitors/etc, with varying risk profiles for clot formation, both treated and untreated. The above-mentioned drugs all work in different ways, affect clotting in different ways, have different pharmacokinetics and pharmacodynamics, differing availability of antidotes (or none at all), different levels of bleeding risk, etc. Whether you should be engaging in contact sports while on these drugs, and if so, how to manage your medications is a discussion you should have with your doctor. I am a physician and I find the above recommendations reckless and dangerous.

 

[crgildart]

There's a lot of BS being thrown around on this thread by people who do not appear to understand what they are talking about. First and foremost, I would definitely not recommend getting any medical advice from an anonymous internet board. There are any number of reasons people are on anticoagulants/platelet inhibitors/etc, with varying risk profiles for clot formation, both treated and untreated. The above-mentioned drugs all work in different ways, affect clotting in different ways, have different pharmacokinetics and pharmacodynamics, differing availability of antidotes (or none at all), different levels of bleeding risk, etc. Whether you should be engaging in contact sports while on these drugs, and if so, how to manage your medications is a discussion you should have with your doctor. I am a physician and I find the above recommendations reckless and dangerous.

Any decent physician would tell their patient not to ski on anticoagulants, any anticoagulant. That's why my wife won't try skiing. If we had any intention of doing anything risky she'd stop taking them and check her INR. You're right that Vitamin K doesn't work to counter all varieties of anti coagulants. We've been managing several for the past 15 years.. Heparin, Lovenox, and Coumadin/wafarin.

Regardless, if the person chooses to ski at all or any other activity that involves speed and balance with falls being fairly common they are definitely doing so against any reputable doctor's recommendation. So, on to the internet... We could suggest a wearing a helmet but then someone will try to claim that helmets give a false sense of security which encourages the skier to take even greater risks. The only right answer is don't ski.

 

[Beartown]

Any decent physician would tell their patient not to ski on anticoagulants, any anticoagulant. That's why my wife won't try skiing. If we had any intention of doing anything risky she'd stop taking them and check her INR. You're right that Vitamin K doesn't work to counter all varieties of anti coagulants. We've been managing several for the past 15 years.. Heparin, Lovenox, and Coumadin/wafarin.

Regardless, if the person chooses to ski at all or any other activity that involves speed and balance with falls being fairly common they are definitely doing so against any reputable doctor's recommendation. So, on to the internet... We could suggest a wearing a helmet but then someone will try to claim that helmets give a false sense of security which encourages the skier to take even greater risks. The only right answer is don't ski.

While not skiing (or pursuing other high risk activities) is certainly safer for folks actively taking anticoagulants/antiplatelet drugs, some folks may be perfectly fine coming off these drugs intermittently to pursue their passions. Others may not be. That's kind of the point I'm getting at about internet advice: without all the appropriate information and expertise, people can give/get some really dangerous advice. For example, your advice above:

Just eat a big bowl of collard greens the day before you go skiing and get right back on your anti coag après ski?? Odds of clotting are low unless you have a long drive or flight to deal with where you have to sit still for hours and hours..

That might be perfectly reasonable advice for someone on a stable coumadin dose for atrial fibrillation. It also might kill someone on coumadin for a mechanical aortic valve. it would have no effect on someone on any other blood-thinning agent (heparin, lovenox, plavix, eliquis, reopro, angiomax, pradaxa, arixtra, effient, xarelto, brilinta, etc), leaving them at severe risk of a potentially life-threatening hemorrhage. A number of the most popular novel anticoagulants don't have any antidotes, so if you get a brain bleed, gotta just wait out the half-life (which won't matter as you'd likely be a vegetable after the first few hours).

While obviously you and your wife's experience is valid and may be of interest to others on the board, nobody (including me) should be telling random strangers what to do with their medications over the internet. People are very very dumb, and will definitely do things "because the internet said so". I am a frequent contributor on a message board for physicians. Any thread that gets into medical advice (which random "civilians" frequently ask for after finding the boards on google) is immediately locked and/or deleted, because we've all seen it go bad before. The right answer is always "ask you medical professional" (or shaman or whatever; no judgement).

 

[SkiNurse]

@Beartown I couldn't agree with you more. I discuss anticoagulation therapy with patients &families frequently. Many different medications for many different medical conditions. YOU can live on anticoagulation therapy and also need to know that there are sometimes choices in which medication is best for which condition AND is best for your lifestyle. As you said, these conversations are best had with the individual's medical practitioner.

 

[Magi]

Thanks for sharing your expertise @Beartown

Slightly off topic but potentially of interest, the history of the discovery of blood thinners: https://www.npr.org/sections/health...y-hay-and-sick-cows-led-to-a-life-saving-drug

 

[SpikeDog]

I'm going to visit the doc in 2 weeks. will demand getting off anti--coagulants as the problem triggering it only occurred once 4 years ago. Cardiologist even wonders why I visit as he has never found any problem.

With the username MDSKIER, I thought you were a doctor yourself, John. Either that or from Maryland...

 

[crgildart]

While not skiing (or pursuing other high risk activities) is certainly safer for folks actively taking anticoagulants/antiplatelet drugs, some folks may be perfectly fine coming off these drugs intermittently to pursue their passions. Others may not be. That's kind of the point I'm getting at about internet advice: without all the appropriate information and expertise, people can give/get some really dangerous advice. For example, your advice above:



That might be perfectly reasonable advice for someone on a stable coumadin dose for atrial fibrillation. It also might kill someone on coumadin for a mechanical aortic valve. it would have no effect on someone on any other blood-thinning agent (heparin, lovenox, plavix, eliquis, reopro, angiomax, pradaxa, arixtra, effient, xarelto, brilinta, etc), leaving them at severe risk of a potentially life-threatening hemorrhage. A number of the most popular novel anticoagulants don't have any antidotes, so if you get a brain bleed, gotta just wait out the half-life (which won't matter as you'd likely be a vegetable after the first few hours).

While obviously you and your wife's experience is valid and may be of interest to others on the board, nobody (including me) should be telling random strangers what to do with their medications over the internet. People are very very dumb, and will definitely do things "because the internet said so". I am a frequent contributor on a message board for physicians. Any thread that gets into medical advice (which random "civilians" frequently ask for after finding the boards on google) is immediately locked and/or deleted, because we've all seen it go bad before. The right answer is always "ask you medical professional" (or shaman or whatever; no judgement).

Sorry, I forgot my sarcasm font and after the collard greens comments. Pretty sure I concluded with not skiing is the best recommendation... unless you check the INR to be sure you're clean.

Starting with "I'n not a doctor and didn't stay at a Holiday Inn Express" should have been a clue that what followed was going to be totally off the cuff and not to be taken seriously.,

To be sure I concluded with..

That said, wife doesn't ski or do anything at all with significant risk of a fall. If she already knew how to ski and ski well she'd probably do it and take it easy. With a much greater risk of falling while learning, it isn't worth it since she will definitely fall learning. She'll ride a bike around the block though since she already feels comfortable and not afraid of falling there.[/QUOTE]

Really though I had every expectation that this thread would have been locked or removed for the reasons you lectured about above.

 

[fatbob]

Fair points but I asked here for 3 reasons:

1 being pretty sure that there would be some people here who participated in skiing despite being on anti coags

2 The teensy problem of asking your physician being official medical advice which might then void insurance cover if breached.

3 Physicians tending toward the conservative in their advice.

The lack of reversibility does concern me about the modern anti coags. An otherwise minor car accident or a simple slip and fall could have vastly worse consequences.

 

[SkiNurse]

The lack of reversibility does concern me about the modern anti coags. An otherwise minor car accident or a simple slip and fall could have vastly worse consequences.

Yep. My docs will say that the new anitcoagulants are a trauma surgeon's worst nightmare.

Warfarin (Coumadin) is "easy" to reverse compared to the modern day anticoagulants with fresh frozen plasma and Vit K. There are some newer reversal agents on the market for both Brillinta & Xeralto (I think). But they are not readily available at all hospitals AND very expensive. Before those reversal agents came on the market, we would use dialysis in certain situations (emergency heart or trauma surgeries) to help the body clear out the medications. And yes, dialysis can be done during surgery.

 

[Grizzly777]

I'm sorry If anyone has been offended or upset I am not suggesting anything for anyone to take. It is your body do your research and find doctors with competent critical thinking skills being important to work with you in tx. I myself had good luck with a natural over the counter product but that is for me and I am not offering any advice. I'm an adrenaline junkie in most things I participate in so for me I don't want the risk of prescription blood thinners or dealing with their side effects for myself. I do believe in alternative healthy options for myself that I think many are quick to dismiss and if prescription med tx is needed and is the best course of action so be it. I do think there are bias in some prescription med tx but not all. In the past I was being forced to participate in some bias med tx studies with only positive options for prescription med tx for my documentation and that didn't sit well with me on the ethical end. Plus free open bar and $100 steak dinners every week discussing pharmacology for only a short 10-30 minutes mostly shooting the bull about surfing powder on skis. I have come to the conclusion it is a sick world we live in at times. Years ago I watched a decent handful of people at end of life getting MOST BUT NOT ALL of their prescription med tx discontinued and then start thriving, walking, talking, eating, gaining weight and cognitive skills returning again. Now that was a priceless observation to watch quality of life returning back in the day and really opened my eyes!! That was also done with a team closely monitoring.

 

[Posaune]

Nobody has said it yet that I noticed, but I am a skier that takes anti-coagulation drugs (warfarin). I do it with my eyes wide open. My doctor has not told me that it's a bad idea, though the subject of skiing has come up. I have an artificial aortal valve due to a birth defect. As long as I keep my diet steady I have it under control, it seems. No problems so far and I've been doing it for over a decade.

 

[tball]

There's a lot of BS being thrown around on this thread by people who do not appear to understand what they are talking about. First and foremost, I would definitely not recommend getting any medical advice from an anonymous internet board.

With respect, patients having discussions of this sort can be a way we learn about what questions to ask our medical professionals. We know it's the Internet and full of crap and we learn how to filter the crap.

As you know, doctors have limited time to spend with their patients. Doctors are also often wrong. On the flip side, it could be considered reckless for a patient just to trust their doctor. At least get a second opinion, and third... you'll be surprised how different the answers may be.

There are a lot of smart people on forums like this. Their experience can be exceedingly helpful, especially when it comes to details like how skiing might impact one's medical condition. They have lived it.

Slowtwitch, for example, is a triathlon forum that has a culture of constructive medical discussions in which a good number of smarts docs participate. I would prefer to see replicated here rather than just shutting down conversations with the standard "ask your medical professional."

@fatbob here's a search on Slowtwitch showing conversations about Eliquis that might be helpful:
http://forum.slowtwitch.com/forum/?...search_type=AND&search_string=Eliquis&search=

 

[crgildart]

Nobody has said it yet that I noticed, but I am a skier that takes anti-coagulation drugs (warfarin). I do it with my eyes wide open. My doctor has not told me that it's a bad idea, though the subject of skiing has come up. I have an artificial aortal valve due to a birth defect. As long as I keep my diet steady I have it under control, it seems. No problems so far and I've been doing it for over a decade.

OK in my serious font.. Do you think you're not at risk of a brain bleed problem if your INR is under 3? @Beartown and @SkiNurse is the risk mostly related to elevated INR instead of it being in the normal range.. i.e. if they have over thinned? Just wondering if the risk is patient or med error more than simply being on the product when it's actually dialed in right?? I was under the impression that even dialed in right 2-3 range, natural clotting is still impaired when using the product correctly.