Rehabilitation from Thrombosis

Hi Everyone

I have written a couple times on this excellent forum and would just like to ask for some advice on rehabilitating from Deep Vein Thrombosis.

It's been 18 days since I was diagnosed with a blood clot in my Subclavical vein, at the site of the entry of the leads of my Pacemaker. This happened 6 weeks post operation. I initially injected Hibor (Heparin) for 2 weeks and then I was thankfully moved onto Apixaban. I was offered the choice of Warfarin or Apixaban. Warfarin is much cheaper here in Spain, but I didn't think twice about getting the newer and more expensive drug.

I have started my rehabilitation to get back to my work as a Cycle Guide and back on the road. My Physician says it could be 6 months on blood thinners but is optimistic I can do it in 3 months due to my age and fitness. Apart from some light strength and conditioning, I have done 3 one-hour training sessions on a indoor bike, every other day, and keeping the intensity under 70%. Yesterday, I pushed a little harder - to an average of 149 bpm. Immediately after, I felt amazing but then, at night, felt pressure around the heart and brain and didn't sleep very well. 

My Physician has said I would have plenty of ups and downs but to monitor my arm and make sure it doesn't swell (which it hasn't).

I will take it easier today and cut back on the intensity on the bike as the coagulation is clearly still an issue.

I have 2 questions:

1. At what intensity can I push the body and is there a point where exercise can be detrimental or even dangerous?

2. I need to get back to work and cycle guide on the road but I am currently on blood thinners. What precautions will I need to take with the increase in risk from internl and external bleeding?





Thank you for the update

by Gemita - 2023-12-22 12:34:07

Phil I am so sorry to hear this, but I am glad you received a firm diagnosis in the end and that you are receiving appropriate treatment. 

What dosage of Apixaban are you on?  5mg x 2 daily? Apixaban is one of the safest of the direct oral anticoagulants.  I was taking it for another condition and was fine, even when I had a fall.  I suffered bruising, but that is all and never experienced any serious bleeds or bowel distress while taking Apixaban for approx 3 months.  I was switched to Edoxaban low dose for low body weight and have been on this for almost 5 years without any problems at all.  

I see you were probably on a higher dose for the first 7 days, so I hope you are taking a maintenance dose now of Apixaban 2 x 5 mg daily.  Many members are taking Apixaban for stroke protection.  Reference your two questions:-

1. Don’t push beyond what is comfortable for you is perhaps the safest advice anyone can give after your complication, but would this suit your lifestyle?  It is better in my opinion to pace yourself (low to moderate intensity exercise) rather than to push too hard. This is still very early days following your thrombosis.  Exercise should not be painful 

2.  Unless you have a serious accident, a fall from your bike, is unlikely to cause a major bleed, although you might have some pretty nasty bruises that will take longer to heal.  

Make sure that you keep your Apixaban with you when out cycling

by crustyg - 2023-12-22 12:52:01

I didn't let my nearly two years of Apixaban stop me road cycling.  But I did carry both my Patient-on-Apixaban card *AND* the current pack of medication with me when cycling.

If I had come off my bike whilst on Apixaban and wasn't in a position to explain why my grazes wouldn't stop bleeding, it's a fair bet that folk would find the Apixaban long before they noticed the little card in my wallet (or perhaps it would have been the other way around.....?).

Having a PM and being on Apixaban shouldn't make you feel as though you need to be wrapped in cotton wool.  But that's just my take on life.

Best wishes.

Great Advice Thanks

by Philmtb - 2023-12-23 07:05:25

Thank you again Gemita & crustyg for your excellent advice. I am on Apixaban 2 x 5mg and I am much happier to be using that than Warfarin, particularly taking your comments into consideration.

I will keep my exercise intensity down for now, but it is hard due my lifetime in high level competitive sport and my natural tendency to push my body. However, the setbacks are just not worth it! 

As for cycling outdoors, it is something I need to do for my job, and I will just have to take the extra precautions, such as care around other riders and informing others of my condition and carrying the card and / or the medication. There should be some sort of wrist band for this.

Best wishes


Wrist band

by Selwyn - 2023-12-23 14:06:55

You can always wear a medicalert bracelet ( or similar.

Dehydration predisposes you to thrombosis. Be careful.

Andexanet is NICE approved for use only in life threatening or uncontrolled GI bleeding to reverse anticoagulant effect of apixaban. Prior to that are general bleeding supportive measures.

Make sure that someone with haematological knowledge checks you for coagulation disorders and your general health as some conditions predispose to thrombosis. 

Take care, best wishes.


Hi Phil

by Julros - 2023-12-23 16:00:35

I've been on apixiban for 4 years without a problem. I cycle casually, but I have taken a tumble or two. Scrapes bleed alot! and I twisted my ankle once that took some time to resolve. To prevent serious bleeding, be sure you wear a well-fitting helmet. I also wear gloves. My son, who is also on abixian and much more serious about cycling than I, has not had any issues either, other than the time he was struck by a car, flew over the hood and landed on his face. Helmet protected his brain, but he needed stitches over an eye. Bike was toast. 

You should avoid NSAIDs like ibuprofen, and certain herbal supplements, like tumeric that can increase risk of bleeding. A trusted pharmacist can be a wonderful source of info on drug interactions. You will likely be advised to hold the apixiban before certain procedures, like dental work and colonoscopy. 

Awesome Advice Guys

by Philmtb - 2023-12-29 11:41:53

Once again you guys are amazing - this is so helpful and I am extremely grateful for your responses. First, I will certainly get one of those bracelets! I usually supplement my breakfast smoothie with Tumeric so now I have stopped that. I will avoid ibuprofen too and keep well hydrated, particularly when cycling. I will ask my Physician about Andexanet, as that could be a lifesaver. I have also organised for a Coagulation test to see what my propensity to clotting is. I'm really happy to hear that you all seem to continue living full active lives despite the risks. All the best and have a great 2024!

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