Warfarin

I'm in the field.

by Zackalope - 2019-06-06 23:27:59

Concerning warfarin and skiing.....Yeah you might want to modify your lifestyle. A moderate fall while not on warfarin which might not even have bruised might result in a hospital trip (or worse) on warfarin.

Hiking, I think if you were careful would be a different story.

I am not on warfarin, but just got certified as an RN so take it with a grain of salt, but ask your primary provider about skiing. I would skip it if you were only asking me.

Not this reporter

by AgentX86 - 2019-06-06 23:36:05

I hated being on Warfarin but I'd certainly not be doing any physically hazardous activity while on it.  The bleed risk is just too high.  Yeah, it can be reversed but so can the Xa inhibitors, now.  It's expensive but it can be done if necessary. They're also faster to act and faster to clear the system on their own.

Me neither

by IAN MC - 2019-06-07 11:33:19

I think my answer is influenced by the fact that I have just this morning returned from visiting a good friend in hospital . He is on one of the newer blood thinners, , apixaban ( Eliquis ) and suffered a severe brain bleed after a relatively minor bang to his head.   After a week in intensive care it seems that he will recover but is likely to have permanent memory loss.

So how cautious should you be when you're on warfarin. I guess it comes down to how likely are you to bang your head ?   It is highly unlikely that you will have a skiing accident which in turn leads to a brain bleed BUT you never know !    If it were me I would think long and hard before skiing while on warfarin..but would not hesitate about hiking.

I used to be on warfarin and led a pretty normal life with plenty of normal activities ( running, cycling ,golf and tennis  )so it really is your decision and it depends on how risk-averse you are.

Best of luck with your valve transplant . If you do have an artificial one then you need lifelong anti-coagulation . I may be wrong but I don't think the newer blood-thinners have a licence yet for clot prevention following valve transplant so unless the evidence has changed  then warfarin it is !

Ian

There's a contrarian in every crowd!

by donr - 2019-06-08 00:57:18

And it's ME!

Protect your head!  It's easy!

I was put on Warfarin back in 2002  0r 2003, following a "TIA" following a heart cath.    Finished the cath at about 9PM, went home & had the event sometime while asleep.  Awoke in AM & tried reading & replying to e-mail.  Fingers were off at least three keys & I typed gibberish.  Went to eat breakfast & shoved a forkfull of scrambled eggs up my nose.  Tried the touching finger tips together while eyes were closed & missed by many inches.  STROKE!.  Hopped in car & hotfooted it to hosp.  confirmed as asome sort of brain event.  Was resolving itself w/i a hour .  Symptoms completely gone in less than three days.

OK - put on rat poison.  MD Daughter tells me "Dad, NO MORE ladders for you.  I see at least one patient a month in the ER that has fallen off a ladder, hit his head & doesn't make it to the ER in time."  So I say to her - Elaine, I have to finish building the house - that means ladders.  How about if I buy & wear a skateboarder's helmet. "  she stops, mulls it over (mullimg is good) & says OK. " so we are off to "Sports Authorty " to buy one.  There I stand in amongst all the teenagers (at age 66) with the straps flapping ;loose.  & I say to her - "If this is so great, why don't I wear it while driving in the car?" (After all, jet pilots wear them; how much cooler can you get?)  She points a finger at me & sneers "Good idea, Dad!"  So a wise crack sealed my doom of looking like a sap riding around in a mini van wearing a skateboarder's helmet. 

But wait - read on - there's a lot more irony to this tale.

A few weeks later, the entire Donr clan is gathered for a pumphouse raising.  Just like the Amish in Pennsylvania.  My #1 grandson dropped a carpenter's hammer on my head!  Helmet saved me.

But it gets better!

I wear this thing religiously while in the car.  Man, do I get funny looks from bearded bikers on Harley Hawgs.  I just smile & wave at them. 

Slow forwarfd to June 12, 2007.  I'd had a new lead installed a mere 2-1/2 months earlier.  Pack the car for a trip to see MD Daughter about 500 miles away.  Half the collectoin of tools I own to do some projects & a pair of dustmop dogs.  Wife drives, as usual.  Making a left turn into a restaurant, I look out the passenger side window & what do my wondering eyes spy but the hood ornament of a Jeep Cherokee heading for my right shoulder at a range of about 50 feet.    I yell out "We're gonna get...POW... "  that ornament hits the door post behind me & drives it into my right shoulder.  All the airbags deploy.  My head goes through the door window, spraying shattered tempered glass all over the street.  My fear was that we'd roll & I'd get buried in tools & dustmop dogs.   Wife & dogs came out unscathed.    My list of injuries reads like a primer for first yr med students - 8 broken ribs, broken collar bone, lacerated liver, bruised kidney, collapsed RLL of my lungs, a brand new aortic aneurysm, suspected concussion & broken neck, potential broken back. 

I was on Coumadin,  INR was coasting along at about 2.5, like it should.   I was wearing a neck tag that said "Coumadin, Pacemaker."  It was over an hour before anyone found the tag!    No one could figure out why I had NOT A MARK on my head after it had gone through a window. 

I WAS WEARING MY HELMET!

A quick shot of Vit K in the buttocks took care of my INR in very short order. 

Afrter over 16 yrs on coumadin, I have come to some conclusions about bleeding from cuts:

1)  Minor cuts & scrapes don't matter - you rally cannot tell much difference from bleeding pre Coumadin.

2)  Cut an artery & it doesn't matter - the treatment is the same - high INR makes no difference in that bleding. 

3)  The intermediate wounds are where you see & feel a diffeerence.  They require longer & harder pressure to make them clot. 

4)The same applies to internal bleeding.  You as the patient have to be alert to injuries & get to medical attention ASAP when they occur.

5)  You can worry too much About coumadin & bleeding to the point you cripple yourself.   You can also be blase' about it I endanger yourself.   Somewhere in the niddle is the optimum position & attitude. 

5)  A 2.5 INR will not make one hill of beans difference If you cut an artery of any size.  They just don't clot up.  Even if your INR is 1.

Donr

Don

by IAN MC - 2019-06-08 08:44:37

You must be the oldest skateboarder in Georgia ! 

I think your reply is very relevant to NICBRIDGE's original query re skiing while on warfarin.

  It is interesting that more and more people are wearing helmets when skiing,  But if you do a search on the subject , there is evidence that while ski helmets give protection from head injuries like gashes and bruising ,  the same may not apply to concussion.

But, NIC,   if I was to ski while on warfarin , ( or any of the blood-thinners ) , I would definitely wear a ski helmet.

Ian

PS  Don.. do you still have a nose full of scrambled egg , or was it surgically removed ??

Surgical removal of ...

by donr - 2019-06-09 00:54:16

....glutanous masses in n asal passages...  Nah, It's stilll up there masquerading as brains.    Thy did an MRI (this was pre-PM)  of my head to fgind out if there were any remnants of the Tia - you know what they found in my head????? NOTHING!  But you suspected tyhat all along, I'll bet. 

I have never skied, so I have no idea what a ski helmet id like.  But there id an inc plus pf foam inside the shateboard jobs.  Probably why I suffered no head injury as my head went through the window.    That helmet has about as much thickness of padding as a fighter jock'd helmet - but not as good, but it will take quite a wallop w/o causing a lot of damage.  The main thing it does is spread out the force of the blow over a large area of skull. 

The main thing I have noticed is the spread of bruising down thewe leg after getting a bad knock on the butt or front of the thigh.  I've badly bruised both  & had it spread all the way to my big toe.  There's a lot of space between muscles for clood to flow through & gravity really helps it out.    A few weeks ago I had a wicked case of bursitis in my left hip.  that plus a really tight knotted up pitoformus (SP?) muscle.  I went to see my family Chirppracteor who diagnosed me.  He massaged the muscle hard, which really loosened it up & gave nme relief, but three days later I had a bruise behind the knee.  That was as far as it went, fortunately. 

Ianl a really funny part of that accident - in retrospect, of course.  The impact did in 8+ ribs & the cpllar bone.  Naturally it knocked the breath out of me.  I ws sitting in the car, unable to b4reath & started screaming at the top of my injured lungs "I can't breaty, I'm dying, I'm dyimng!"  That went on for several minutes.  The screaming was interspersed y periiods of comp,ete silence.  Wiofe was uninjured & gets out of the car & starts calling our Cardio to ask where to send me to as hospital  She yells over to me asking for his phone number.  I responded by the screaming again.  She yells at me "Shut up, you aren't dying!"  Then I realized I wa sable to breath, but not very well, so I shut up & yelled the 10 digit phone number to her.  That convinced me that my brain probably wasn't hurt, because I could think & answer questions. In retrospect I realized thet the yelling helped me breath - it emptied my lungs, resulting in silence & relaxation & my lungs partially filled, leading to the next yelling spree.   Probably helped trememdously at getting my body functioning again.  I had my seatbelt fasstened, so that provided a lot of protection by keeping me from hitting anything during the impact.  As soon as things dettled down a bit, Wife came & started taliing to me to engage the brain so I would not go into shock.  I did not move a limb, not knowimg the condition of my spine & neck.  I started exploring my sensory & motort nerves by wiggling fingers & toes to see if I had feeling & if the extremities functioned.   Everything seemed to function OK.  NO bleeding anywher externally.  I had no idea what was internal, but I knew for sure that my chest hurt like H%$#. 

I did not knw how badly I was injured & didn't find out till our #1 Son walked into the rooom 2 days later.  He was in Iraq at the time & they notified him & the Army sent him home.  .  So someone thought it was serious.  It all ilustrated what Napoleon said in 1796 - "In battle, the mental is to the physical as three is to one!" 

Cheers!

Donr