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Blood thinners and skiing (coumadin or warfarin)

post #1 of 29
Thread Starter 

I was just diagnosed with 3 small clots in my lung and am now on Coumadin for at least 6 months, but since I have a genetic blood problem, I will probably need to be on it for the rest of my life.  Doctor read me the riot act about risky stuff and the risk of cutting or bruising myself and told me that since skiing is risky, I would need to decide for myself if I should ski this year or give it up.  I personally want to keep skiing, especially since I bought a 5-pack to Copper Mountain and a 4-pack to A-basin/Keystone this year.  Doctor gave me a written excuse to try to get my money back on them, but the Epic pass people (where I renewed my A-basin/Keystone 4-pack) can be jerks on refunds.  I think I can get my money back on Copper, though.

 

I am pretty much an intermediate/advanced skiier who mostly skis with my 8 and 12 yo daughters, and this year my 5yo son wants to ski a few times, too.  I mostly ski the greens and easy blues these days (hoping for a powder day, too), so I haven't taken much risk these days.  I'm not the kind of skier that would try skiing the trees or bumps.  But I hate to miss skiing with them this year.

 

My MIL lives near Mt. Bachelor in Oregon and there are a lot of retirees who ski there and MIL says that she is willing to bet that many of them are on some kind of blood thinner and are skiing.

 

Any opinions on this?

 

Thanks.

post #2 of 29
Hi, neustkg.

Sorry to hear about your condition. One idea is to Google Kristen Ulmer. She is an ex rock star skier and I believe she was on cumadin for awhile several years ago. She is still a great skier and now does coaching and inspiration stuff. I would bet she would be happy to talk to you about her experiences.

Good luck and stay safe.
post #3 of 29
Does elevation impact the likelihood of a blot clot forming? If so then moving to Bend is not a bad idea, top elevation at Batchelor is 9000 feet. Nice intermediate slopes and few bumps.

As far as whether or not you should ski.....most on this forum, I think, would want to ski up until the point they are physically unable, or dead, whichever comes first.

Ski with caution and sense, become familiar with ski patrol, have a medical ID tag, ski with a buddy, don't overdue it. Get a boot fitter to make your boots fit as perfectly as possible to prevent bruises, since that where most of the pressure on your body will be.

Have fun.
post #4 of 29

Mrs crgldart's a clotter too.  She's not even supposed to go on amusement park rides for fear of a small bump on the head becoming an unstoppable stroke if her levels somehow go too thin.  We do have our own monitor now though.  The problem is that the meds are inconsistant in how they react to your metabolism.  There are too many variables to get it perfect every time.  It can be very scary to see an INR above 8 when we'd been following the dosing instructions to the letter. It's happened about four times in the past 8 years.

 

So, that is why it is risky to ski on anti coagulants.  My wife won't do stuff like that anymore, but I would if it were me.  To me it is worth the risk.  However, having a monitor and test strips decreases the odds of being too thin and not knowing it.  The monitor is about $450 and the test strips are $10-$50 a piece depending on how you buy them and from where..

post #5 of 29
They just put my brother on Dabigitran and took him off Warafin. I think he told me if there's a problem when you're on Warafin, there are still ways to save you, but not if you're on Dabigitran you'll bleed out before you get to the emergency room. Might want to ask about that.

Edited for right drug name.
Edited by sibhusky - 11/6/13 at 2:43pm
post #6 of 29

I've been on Coumadin for about 5 years due to an Afib problem. My doctor never read me the Riot Act or anything like that. He told me to bear it in mind but otherwise encouraged me to do whatever I normally do. I spend a fair amount of time in the woods in the summer, hiking and bushwhacking in shorts and I get all kinds of scratches on my legs from briars and brush and I've never noticed that I bleed profusely. A couple weeks ago I dropped a small tree on my foot while being dangerous with the chainsaw and I did have some black and blue but nothing alarming. Your INR can vary widely depending on things like diet. If you can get your insurance co. to pay for a testing device like a Coagucheck you can keep a close eye on your PT INR and keep it safely within bounds.(between 2,0 and 3.0)  I'm not medically qualified to advise you on the subject so I can't say if your situation is not different from mine but I would get a second opinion if you are concerned. Make the doctor understand that skiing is important to your quality of life and fitness. I'm planning on skiing a lot this winter myself. 

post #7 of 29
Quote:
Originally Posted by sibhusky View Post

They just put my brother I think on Coumadin and took him off Warafin. I think he told me if there's a problem when you're on Warafin, there are still ways to save you, but not if you're on Coumadin, you'll bleed out before you get to the emergency room. Might want to ask about that.


Warfarin is simply the generic equivilant of Coumadin, you're screwed on either one.  It is Heparin that clears your system a lot quicker.  We had to shoot heparin in the wife 6 times a day while she was pregnant.  But, having her on heparin made it more possible to do emergency c-section if suddenly necessary.

 

Just for the record, and against coag therapist advice... Eating a can of green collards provides enough vitamin K to bring the INR levels back down to 2.5 from off the scale within about 24 hours. 

post #8 of 29
Quote:
Originally Posted by sibhusky View Post

They just put my brother I think on Coumadin and took him off Warafin. I think he told me if there's a problem when you're on Warafin, there are still ways to save you, but not if you're on Coumadin, you'll bleed out before you get to the emergency room. Might want to ask about that.

Warfarin and Coumadin are the same thing. One is just a proprietary name for the drug. I think they have way exaggerrated the risk. There are new alternatives to Coumadin that do not require frequent testing and I presume they might be safer in that the risk of "overthinning" is lessened..

post #9 of 29
I went hunting through my emails and it turned out it was Dabigitran.

He had to take a trip to Italy, I think he was still on the Warafin. They made him take all kinds of crazy connections with long layovers of walking to minimize blood clots. Took him two days out, three days to get back. This is all related to a pulmonary embolism.
post #10 of 29
Quote:
Originally Posted by oisin View Post
 

I've been on Coumadin for about 5 years due to an Afib problem. My doctor never read me the Riot Act or anything like that. He told me to bear it in mind but otherwise encouraged me to do whatever I normally do. I spend a fair amount of time in the woods in the summer, hiking and bushwhacking in shorts and I get all kinds of scratches on my legs from briars and brush and I've never noticed that I bleed profusely. A couple weeks ago I dropped a small tree on my foot while being dangerous with the chainsaw and I did have some black and blue but nothing alarming. Your INR can vary widely depending on things like diet. If you can get your insurance co. to pay for a testing device like a Coagucheck you can keep a close eye on your PT INR and keep it safely within bounds.(between 2,0 and 3.0)  I'm not medically qualified to advise you on the subject so I can't say if your situation is not different from mine but I would get a second opinion if you are concerned. Make the doctor understand that skiing is important to your quality of life and fitness. I'm planning on skiing a lot this winter myself. 


This could be me. I'm on Warfarin and I ski around 50 days per year.  My doctor has never told me to worry about it, but just be aware.  I completely agree with everything oisin says.

post #11 of 29

If cutting yourself and bleeding out is a concern, you might consider keeping a hemostatic agent with you when you're concerned about injury.  I haven't researched all of them, but at least Celox isn't slowed down by warfarin.  It can be a useful thing to have in your first aid kits in general, but especially if you're on drugs like that.

post #12 of 29
OP: There are a number of retirees skiing where I work, and it seems like every year we have someone on blood thinners get a cut. Sometimes it's not too bad, sometimes it gets a little wild. Consider carrying some compresses so you can have them handy, and also consider a medical alert bracelet or necklace if you haven't gotten one already.

As a patroller I've treated an on-hill accident where the pt. was on Coumadin. He fell on his face (in a pretty easy spot) and his nose bleeding was profuse - really profuse. There wasn't any other significant injury but it was very difficult to control the bleeding. We used up all the compresses I had in my vest and then some more from the trauma pack just while getting him ready to transport. If you have some compresses handy that could be very handy in the case of an event. I don't think you have to give up skiing if you prepare for the possibility of a laceration or contusion, and, of course, be careful.

Just sayin... And get well soon.
post #13 of 29

As long as your INR is in the therapeutic range (2-3) you are perfectly safe to ski. Altitude would have no affect on blood thinning properties. Keep skiing!!!!!!

post #14 of 29
Quote:
Originally Posted by neustkg View Post
 

I was just diagnosed with 3 small clots in my lung and am now on Coumadin for at least 6 months, but since I have a genetic blood problem, I will probably need to be on it for the rest of my life.  Doctor read me the riot act about risky stuff and the risk of cutting or bruising myself and told me that since skiing is risky, I would need to decide for myself if I should ski this year or give it up.  I personally want to keep skiing, especially since I bought a 5-pack to Copper Mountain and a 4-pack to A-basin/Keystone this year.  Doctor gave me a written excuse to try to get my money back on them, but the Epic pass people (where I renewed my A-basin/Keystone 4-pack) can be jerks on refunds.  I think I can get my money back on Copper, though.

 

I am pretty much an intermediate/advanced skiier who mostly skis with my 8 and 12 yo daughters, and this year my 5yo son wants to ski a few times, too.  I mostly ski the greens and easy blues these days (hoping for a powder day, too), so I haven't taken much risk these days.  I'm not the kind of skier that would try skiing the trees or bumps.  But I hate to miss skiing with them this year.

 

My MIL lives near Mt. Bachelor in Oregon and there are a lot of retirees who ski there and MIL says that she is willing to bet that many of them are on some kind of blood thinner and are skiing.

 

Any opinions on this?

 

Thanks.


This might be a stretch, but maybe Oregon Adaptive Sports could help you out by appointing you two blockers.  They work with folks who have disabilities.  Although you may not technically be disabled, they may still be willing to help you.  It might cost you a few dollars, but I don't know for sure.   Yes, they are at Mt. Bachelor.   The OAS email is info@oregonadaptivesports.org and the operations cell phone is 541-848-9390.  Best to you and good luck.

 

Okay here is an example of some folks who are not really disabled, but OAS still helped them out.  You would not be in a Bi-Ski, but would have two people behind you to prevent people from getting too close to you or hitting you.  Sunrise chair has nice mellow slopes and is super fun.

post #15 of 29
Quote:
Originally Posted by agreen View Post
 

As long as your INR is in the therapeutic range (2-3) you are perfectly safe to ski. Altitude would have no affect on blood thinning properties. Keep skiing!!!!!!


This is correct, but the problem is that you could be tested at 2.5 on Monday, eat a dinner that has a lot of vitamin K in it and then be at .5 Tuesday.  Or, you could have something weird happen to spike you up to 7 or 8.  That is where it gets dangerous.  Unless you were tested the morning you skied you could very well be too thin and not know it.  However, there are some tell tale signs when you get too thin.  Bruising, crazy bruising with no explanation and blood in the stool are the real things that would tell you that your INR may be really high.

 

I'm with Oisin, I'd ski anyway because the odds of that fluke spike are not very high.  However, you can also invest in a monitor, test strips, and test yourself more often to be on the safe side if you are concerned about higher impact activities.

post #16 of 29

The main risk would be the risk of bleeding in the brain. Coumadin won't make you bleed, but if you hit your head (or your spleen or your liver) hard enough to bleed it's going to be hard to stop, so the main risk would be massive stroke. I am unaware of any studies that give any figures for the degree of risk in skiing or any other active sport for patients on warfarin. That doesn't mean there are any. Try searching on Pubmed --the web site for the National Library of Medicine. You might try a search like "warfarin sports"  or even "warfarin skiing". Most docs are going to tell you not to ski because it's easy to tell you that and they don't want to be sued. But it's your decision, based on whatever data you can find. I would get the best helmet I could find--one that's speed event rated, with full ear coverage, realizing that a helmet is no guarantee.

I wouldn't worry about carrying clotting agents. The risk of serious external bleeding--bleeding out through the skin--is extremely small and can be controlled with pressure (unless you manage to put a ski pole tip through your femoral artery in the groin, in which case you're going to die, warfarin or no warfarin.   

post #17 of 29
Quote:
Originally Posted by crgildart View Post
 


This is correct, but the problem is that you could be tested at 2.5 on Monday, eat a dinner that has a lot of vitamin K in it and then be at .5 Tuesday.  Or, you could have something weird happen to spike you up to 7 or 8.  That is where it gets dangerous.  Unless you were tested the morning you skied you could very well be too thin and not know it.  However, there are some tell tale signs when you get too thin.  Bruising, crazy bruising with no explanation and blood in the stool are the real things that would tell you that your INR may be really high.

 

I'm with Oisin, I'd ski anyway because the odds of that fluke spike are not very high.  However, you can also invest in a monitor, test strips, and test yourself more often to be on the safe side if you are concerned about higher impact activities.

These kinds of radical spikes are not something I have experienced. I've found that self testing with the test strips allows me to developing a familiarity with the way in which diet and medication relate to my INR.You could always test yourself in the AM of your ski trip if you wished to be reassured of your safety. I should add that interraction with other medications can require you to alter your dosage. If you've recently been prescribed a new medication you might be wise to test more frequently until you get to know what dosage of Coumadin is appropriate.

post #18 of 29
Quote:
Originally Posted by oldgoat View Post
 

The main risk would be the risk of bleeding in the brain. Coumadin won't make you bleed, but if you hit your head (or your spleen or your liver) hard enough to bleed it's going to be hard to stop, so the main risk would be massive stroke. I am unaware of any studies that give any figures for the degree of risk in skiing or any other active sport for patients on warfarin. That doesn't mean there are any. Try searching on Pubmed --the web site for the National Library of Medicine. You might try a search like "warfarin sports"  or even "warfarin skiing". Most docs are going to tell you not to ski because it's easy to tell you that and they don't want to be sued. But it's your decision, based on whatever data you can find. I would get the best helmet I could find--one that's speed event rated, with full ear coverage, realizing that a helmet is no guarantee.

I wouldn't worry about carrying clotting agents. The risk of serious external bleeding--bleeding out through the skin--is extremely small and can be controlled with pressure (unless you manage to put a ski pole tip through your femoral artery in the groin, in which case you're going to die, warfarin or no warfarin.   

 

^^ Excellent advice here, also on the advantage of Warfarin over Dabigitran as sibhusky and DanBoisvert said.  From Wiki:

 

"Unlike warfarin,[2] there is currently no way to reverse the anticoagulant effect of dabigatran in the event of clinically significant bleeding.[3][4]"

 

Three years ago I was taking warfarin unnecessarily, I should have been removed from treatment a few months at most after a leg infection.  I did an somersault owing to a poorly mounted ski, and had a concussion.  There weren't any noticeable effects (eyes normal, no cognitive impairment).  Well, I felt a headache as I drove home: it was a subdural hematoma, the same thing that killed Natasha Richardson, and I am very lucky to be alive (again).  I still ski but wear the best helmet I can, and avoid any blood thinning agents when I ski.  I cease taking prescribed aspirin two days before traveling and avoid ibuprofen except in very small amounts.  So be careful out there.  If *any of you* bump your head and get a headache, get to a hospital immediately.

post #19 of 29

Re the reversibility of warfarin--in an emergency the fastest way to reverse is fresh frozen plasma transfusion. This requires transport to a hospital and obtaining an INR, thawing and infusing the plasma, rechecking the INR, perhaps infusing more plasma can take hours, which is a long time when your brain is bleeding. Vitamin K takes much longer.

What is your genetic blood disorder, if you feel like saying? 

post #20 of 29

My wife has factor V liden. 

post #21 of 29
Quote:
Originally Posted by crgildart View Post
 

My wife has factor V liden. 

 

Mine has too, but only requires prophylactic thinners like Loxanox for unusual situations, like extended travel and post surgery. She skis and competes in martial arts, so we are thankful to have avoided the need for Coumadin. She would not take the risk of skiing on Coumadin; personal choice of risk stratification.

post #22 of 29

Ya, we did Lovonox during pregnancies, heparin the last couple weeks for reasons discussed.  Lovonox was almost $4K a month back then.  Good thing we had GREAT healthcare coverage. Otherwise it would have been heparin 6 times a day instead of Lovonox twice a day.

post #23 of 29
Quote:
Originally Posted by crgildart View Post
 

Ya, we did Lovonox during pregnancies, heparin the last couple weeks for reasons discussed.  Lovonox was almost $4K a month back then.  Good thing we had GREAT healthcare coverage. Otherwise it would have been heparin 6 times a day instead of Lovonox twice a day.

 

Is there a chance she could come off the Coumadin now that the pregnancies are over? They are about the highest risk women have for throwing clots.(If the question isn't too personal)

 

Being in the medical field, we were able to avoid many of the costs by knowing the right drug reps.

post #24 of 29

NO, she's on it for life.  Otherwise her INR drops too low.  I suppose the other long acting stuff is possible, but not as affordable as warfarin.

post #25 of 29
Quote:
Originally Posted by agreen View Post
 

As long as your INR is in the therapeutic range (2-3) you are perfectly safe to ski. Altitude would have no affect on blood thinning properties. Keep skiing!!!!!!

 

The side effect of taking Coumadin correctly is increased risk of bleeding when injury occurs. This includes the increased risk of death compared to those not on the medication, given the same injuries.

 

You may personally accept the increased risk, but no, not "perfectly safe".

post #26 of 29
Quote:
Originally Posted by MrGolfAnalogy View Post
 
Quote:
Originally Posted by agreen View Post
 

As long as your INR is in the therapeutic range (2-3) you are perfectly safe to ski. Altitude would have no affect on blood thinning properties. Keep skiing!!!!!!

 

The side effect of taking Coumadin correctly is increased risk of bleeding when injury occurs. This includes the increased risk of death compared to those not on the medication, given the same injuries.

 

You may personally accept the increased risk, but no, not "perfectly safe".


Well, "perfectly safe" is not a true condition for anyone doing anything.  As a warfarin user for the rest of my life and a farmer, I find the risk quite low. On the farm I've whacked and bloodied myself many times with no big concerns.  I even put a blade well into my thumb, but I'm still here.  Of course, the risk is heightened for bleeding, but in my life I will worry lots more about other parts of my daily life than skiing.  Just because you take warfarin doesn't mean that you have to be an invalid.

post #27 of 29
Quote:
Originally Posted by MrGolfAnalogy View Post
 

 

The side effect of taking Coumadin correctly is increased risk of bleeding when injury occurs. This includes the increased risk of death compared to those not on the medication, given the same injuries.

 

You may personally accept the increased risk, but no, not "perfectly safe".

True. bad choice of words. I should say the risk is quite low especially if the skier sticks to the groomers with the kiddies.

post #28 of 29
Quote:
Originally Posted by oldgoat View Post
 

The main risk would be the risk of bleeding in the brain.  

 

Yes, this is the main risk you'd be worried about. Definitely get a very good helmet, and if you do take a fall pay close attention to any subsequent symptoms (esp. headache, weakness, or changes in vision). 

 

I did a Pubmed search for "warfarin skiing" which returned 0 results. "Warfarin athletics" and "warfarin sports" returned a few. This paper may be relevant but my institution doesn't have access to this journal for the full text:

http://www.ncbi.nlm.nih.gov/pubmed/23590929

 

I agree that worrying about cuts and bruises is not worth it since it would be unlikely to be life-threatening. However, there was this paper in an orthopedic journal:

http://www.ncbi.nlm.nih.gov/pubmed/19212578

Compartment syndrome is basically increased pressure in a closed space, such as if you had bleeding inside your leg from an impact. The blood flow to the tissues decreases and causes muscle and nerve damage. 

 

As I doctor, I'd probably read you the riot act, too. It just depends on how important skiing is to you. Personally, I'd still ski because I love it. But I'd definitely check my INR before I went to the mountain and if it was higher than, say 4, I might skip that day.

post #29 of 29
Quote:
Originally Posted by kauffee View Post
 

 

Yes, this is the main risk you'd be worried about. Definitely get a very good helmet, and if you do take a fall pay close attention to any subsequent symptoms (esp. headache, weakness, or changes in vision). 

 

 

As I doctor, I'd probably read you the riot act, too. It just depends on how important skiing is to you. Personally, I'd still ski because I love it. But I'd definitely check my INR before I went to the mountain and if it was higher than, say 4, I might skip that day.

Thumbs Up  That's how I see it as well.

 

Theoretically, someone could whack you in the head lowering the safety bar and kill you if your INR is a little too high.  I'd still ski on warfarin too, but would definitely invest in a CoagCheck and strips.  Wife has some but doesn't ski.  Good to test when bruising, bleeding gums, whatever gives us cause for concern.

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