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Chockstone Forum - Accidents & Injuries

Report Accidents and Injuries

 Page 1 of 2. Messages 1 to 20 | 21 to 21
Author
Warfarin Coumadin aka Blood thinners and Climbing

..::- Chris -::..
8-Sep-2010
11:44:12 AM
I've recently beed diagnosed with a mild form of DVT (Deep Vein Thrombosis) mine is not quite Deep Vein (Superficial Vein) meaning the veins near the skin....but anyways I'm now (as of yesterday) on blood thinning Warfarin aka Coumadin...

Obvious risk of bleeding badly from any scratch or cut i receive or in a bad case internal hemorrhaging.

Is anyone else out there on these drugs and still climbing indoors or out ??

Also on a side note when i asked how i got these clots (superficial thrombosis) in my right leg only the doc said have you had any trauma to the leg or been on a plane or sat in a car for a long drive.... Well 4 hrs to the grampians.... I take lead falls in my harness etc.... So the theory thus far (which i don't buy) is that i've got these clots from either the drive to the grampians (which i've been doing for 14 years now) or from one side of my leg loops causing damage to my vein leading to clots which again i've been doing for years.... Weird....

Thanks in Advance,
Chris

Sarah Gara
8-Sep-2010
11:57:37 AM
People get so obsessed with being on warfarin - it just means that your blood will take slightly longer to clot I really wouldn't worry about it -a scratch will stop bleeding fairly quick and certainly wouldn't be a major issue - anything serious and well - you'd be buggered anyway. Just apply direct pressure and elevate where possible. -I certainly wouldn't let it affect my climbing. Do make sure though that you get your INR checked regular - should be having bllood tests for this frequently and they will adjust your dosage accordingly.

Make sure you do ankle exercise on the drive to keep the blood pumping - not obsesivly though as you'll get leg pain. x

..::- Chris -::..
8-Sep-2010
12:06:33 PM
Thanks for your responce it was the one i was hoping for.... ; ) (fine to keep climbing)

i'm not obsessed.... The doctor has said "a bump or fall etc could be up to 100 times worse now" (hence my paranoia) .... He has warned me off climbing, however i'm fairly sure if i stick to well protected climbs for a while I'll be ok....

Just really wanted to see if there were some other climbers out there taking warfarin and if the'd had any side effects / trouble with their climbing etc.....


climbingjac
8-Sep-2010
12:17:21 PM
Where are these clots located? I was talking to someone on the weekend who had DVT once upon a time, and he was not keen on being on warfarin and really questioned it, and was eventually told by his medico that warfarin was not required if the clot was below the knee....

DaCrux
8-Sep-2010
12:33:18 PM
I think people are obsessed with being on warfarin for a good reason. We get dozens of people with therapeutic warfarin levels each year who need brain surgery after bumping their heads on cupboards etc. Iíd get some gradient compression stockings, always make sure you wear a helmet when climbing, and stick to well protected climbs Ė but thatís just my opinion. I donít know your particular situation, medical history etc. Superficial cuts and small bruises arenít normally an issue Ė but if you do have a major injury e.g. break your leg you may need blood products to reverse the effects of warfarin, and your surgery may need to be delayed whilst they lower your INR. These are all things you need to consider.

Climbingjac Ė people still die from clots located below the knee if they break off. Itís not a nice way to go...

DavidC
8-Sep-2010
12:57:22 PM
I agree with DaCrux, you really don't want to be taking a fall even with a helmet where you are hitting your head. I would also be worried about taking a big fall even into space onto you harness. With warfarin there is a risk of having a major bleeding and this would be increased by any activity where trauma is possible.
I also sent you a PM.
prb
8-Sep-2010
1:17:10 PM
On 8/09/2010 ..::- Chris -::.. wrote:

>The doctor has said "a bump or fall etc could be up to 100 times worse now"

This seems a strange thing to say as warfarin is usually used to keep your INR in the normal range or a little bit higher, not turn you into a haemophiliac.

A climbing friend has been on it for years after a heart attack without any problems.

As you probably know by now, be careful taking any antibiotics while on warfarin because they can kill your gut flora which makes a significant amount of vitamin K (a pro-coagulation factor). Hence your INR can really shoot up and you'll bleed.

Billie W
8-Sep-2010
1:20:02 PM
On 8/09/2010 DaCrux wrote:
>I think people are obsessed with being on warfarin for a good reason. We
>get dozens of people with therapeutic warfarin levels each year who need
>brain surgery after bumping their heads on cupboards etc. Iíd get some
>gradient compression stockings, always make sure you wear a helmet when
>climbing, and stick to well protected climbs Ė but thatís just my opinion.
>I donít know your particular situation, medical history etc. Superficial
>cuts and small bruises arenít normally an issue Ė but if you do have a
>major injury e.g. break your leg you may need blood products to reverse
>the effects of warfarin, and your surgery may need to be delayed whilst
>they lower your INR. These are all things you need to consider.
>
>Climbingjac Ė people still die from clots located below the knee if they
>break off. Itís not a nice way to go...
>good advice couldn't say it better

..::- Chris -::..
8-Sep-2010
1:24:46 PM
Thanks for the replies....

The Clot is still in the Superficial Veins, It started below my Calf (again on the superficial vein ) just felt like a bruise, then a few days later same sort of bruise at the side of my knee... When i felt the one at my knee i realized it was a vein and followed the pain back down my leg...... Went to the Doc's... he put me on Voltaren 50mg three times a day (thin the blood etc) however it wasn't stoping the Clot which was heading closer and closer to the money area (groin) where the Superficial and Deep veins meet and as a result here i am ......

Still not sure about the climbing, but I reckon i'll be fine to do the classics, wear a helmet and just climb 6-8 grades easier than what i normally do....

Cheers for the replies...
Chris.

Hans
8-Sep-2010
4:50:20 PM
On 8/09/2010 prb wrote:
>On 8/09/2010 ..::- Chris -::.. wrote:
>
>>The doctor has said "a bump or fall etc could be up to 100 times worse
>now"
>
>This seems a strange thing to say as warfarin is usually used to keep
>your INR in the normal range or a little bit higher, not turn you into
>a haemophiliac.

Just so you're aware, this is incorrect. The aim of warfarin is to keep your inr significantly above the normal range, so that you will be predisposed to NOT clot further. thus you will be at higher risk of bleeding.

>
>As you probably know by now, be careful taking any antibiotics while on
>warfarin because they can kill your gut flora which makes a significant
>amount of vitamin K (a pro-coagulation factor). Hence your INR can really
>shoot up and you'll bleed.

This part however is important to remember.
gfdonc
8-Sep-2010
5:20:33 PM
On 8/09/2010 climbingjac wrote:
>Where are these clots located?

The clots are located all over the Internet. They lurk on forums until someone asks for medical advice.

vwills
9-Sep-2010
8:49:51 AM
>>Where are these clots located?
>
>The clots are located all over the Internet. They lurk on forums until
>someone asks for medical advice.


Brilliant! LOL
prb
9-Sep-2010
4:04:53 PM
I may be a clot but the facts are Chris's INR would be raised only moderately to 2.0 - 3.0 given that this is his first thrombotic event and it's superficial. Increased risk of spontaneous bleeding on warfarin is associated with being older than 65, taking other drugs such as aspirin, or having a medical history of stroke, gastrointestinal bleeding, anaemia, diabetes or a number of other serious conditions that Chris hasn't mentioned. Studies show that low-dose warfarin is pretty safe, eg. 2 of 47 patients in the study of Hull et al. (NEJM, 1982) haemorrhaged but they both had serious predisposing factors such as those above. Certainly, higher INRs of 4, 5 or beyond predispose you to more, and more serious, bleeds.

If I was Chris I'd do as he intends - keep climbing but take it easy and and try to avoid any major cuts.

Sabu
9-Sep-2010
4:18:45 PM
*putting on nit picky researcher hat*

surely there are more recent studies on warfrin than one from 1982?

ajfclark
9-Sep-2010
4:53:18 PM
And with a sample size larger than 47?
prb
9-Sep-2010
5:16:34 PM
Feel free to find us a more recent and larger study Sabu and ajfclark, there's probably something out there. But I doubt whether there'll be any negative controls (patients with clots not on blood thinners), it'll just be INR adjustment versus risk of bleeding.

Hans
9-Sep-2010
7:26:18 PM
i appreciate that the risk of spontaneous bleeds due to being on therapeutic warfarin is not raised that much, and is obviously outweighed by the benefits of avoiding complications of dvt.

the discussion here however is more about the risk of increased bleeding due to trauma when on warfarin. I don't have any studies on hand to reference, but i know that this risk is significantly increased, because of the way that warfarin works. I'm not saying that the original poster should avoid climbing, but that he should be aware that falls and injuries will have a significantly increased risk of serious bleeds while on warfarin.

..::- Chris -::..
9-Sep-2010
10:19:16 PM
Thanks everyone so much for the feedback and thoughts. Chockstone actually has a Doctor and a few nurses around which is really cool. Thanks to those guys esp for giving me there thoughts and opinions.

I went for a Climb / Boulder tonight with no worries. I didn't do any leading or push the grades to much, I did have a slight headache towards the end but I beleive this was more to do with dehydration rather than being knocked about.

Plus my INR has so far only climbed to 1.8 and it needs to sit between 2.5 to 3.0.

Started doubling the dosage today (after blood test and orders from doctor) so we'll see how it goes on Saturday arvo when my INR should be 2+

Thanks again everyone,
Kind Regards,
Chris.

DavidC
9-Sep-2010
11:06:20 PM
For anyone interested there is a much larger study that has just come out in the Lancet. The RE-LY trial looks at warfarin versus a new medication dabigatran and involved over 18000 patients.
The primary safety outcome they looked at was major haemorrhage. They found in 6022 patient on warfarin the rate of major bleed was 3.57% per year. (The study was done for stroke preventation for atrial fibrillation the most common reason for warfarin and the patient population would be older and with other medical conditions.)
prb
10-Sep-2010
12:05:23 AM
Thanks for that DavidC. Hey, it looks that that old study was pretty well on the money doesn't it Sabu and ajfclark!

But seriously, good luck to you Chris. Once a clot is under control, it'll get perfused and break down (harmlessly) over time. Hopefully it's just a one-off for some unknown reason.

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There are 21 messages in this topic.

 

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