# Blood Thinners and Riding



## oldcolonial (Aug 28, 2018)

Hi Sports fans, wondering if I can get some wisdom from the crowd.

Recently, I found myself in a rather scary health situation. I ended up in the hospital with several pulmonary emboli. I was feeling kind of crappy, had been for a number of weeks, noticing that my resting heart rate was going up, up by 25 bpm, and that I had no stamina at all and was easily out of breath. On a particular day it got noticeably worse, to the point where it felt like I might imagine drowning does. A couple of days later I went to see my doc and he sent me straight to the ER where the kind folks there said " we have seen cat scans like your's before, but we have never talked to any one that had one". This was their not so subtle way of telling me that I was lucky to still be among the living. All those years of hard training paid off I suppose in the form of a more robust than average cardiovascular system. This whole experience was also an important reminder that rule number 5 should not be followed absolutely. Sometimes, if you feel like crap, its not that you are getting soft but rather that there is something wrong that needs to be addressed.
At any rate treatment protocol for the emboli is an extended period of a fairly high dose of anti-coagulant medication to prevent the current emboli from growing and or being joined by others while my body's natural garbage collection does the work of clearing the clots. I have seen marked improvement in how I feel after just 3 weeks of treatment and am starting to think about sporting endeavors, including mountain biking again. Initially, the treatment was at the hospital in the form of a heparin drip along with blood tests every 6 hours to get the dosing right, then just shy of three weeks of 2 x 15 mg per day of Xarelto, and now 20 mg per day for the next 2 to 12 months with the potential for a lifetime prescription. Expected value is 6 months though, just enough to take me through to the other side of the peak local mountain biking season. 
Obviously, I will discuss what I am considering doing from a cycling perspective with my primary care doc as well as a hematologist but I would also love to hear from folks in the crowd. Are there folks who might be mountain biking while taking maintenance doses of either Xarelto or Eliquis the two most popular gen two anti-coagulants who would be willing to share their experiences?

Thank you in advance for your perspectives.


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## Riled (May 1, 2012)

I don’t have experience with those two medicines, but just mountain biking with a baby aspirin regimen was a scary experience for me. 

I mangeled my pinky on a tree and it would.not.stop.bleeding. 

I was saved because I had luckily somehow had a premonition and stored some BleedStop in my steerer tube. It saved me as it allowed me to ride the 3 miles back to the car. 

I got back to the car, drove 30 mins, decided I would pause and make a clean dressing so as to not freak out my wife. Even after all that time, the blood gushed again without quitting. I was out of BleedStop and had to drive another 30 mins to a pharmacy to get some more. I ended up making their bathroom look like crime scene to get it to stop again. Then I went to the ER.

Obviously, be careful with your plan. Even if your doc says it’s ok, I would carry a good first aid kit with a lot of coagulant-forcing powder, antiseptic, and bandages. I do now.


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## nOOky (May 13, 2008)

I was on coumadin for many months back in the day, and later Pradaxa. I did not stop doing anything, but you have to be aware that there are some serious side effects. I think the biggest worry was a big hit from a fall. Even a large gash that looks scary will probably be controllable if you can seek medical help. But smacking your chest or your head and not realizing there may be internal hemorrhaging is a big worry. If you suffer a nasty fall it's best to get checked out, regardless of how you think you feel.

Not sure about Xarelto as I wasn't on it, nor if the bleeding can be reversed like with coumadin.


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## A2PM (May 20, 2021)

If you do ride while taking blood thinners take any fall with a helmet hit very seriously. My dad fell a few years ago and seemed fine for two days until major symptoms began to pop up about two days in. The bleeding was likely due to his blood thinners.


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## fredcook (Apr 2, 2009)

As far as thinners go, I was for a period on coumadin (warfarin). During that period, I did not let up on my MTB activity (had no reason to) and kept riding a much and as hard as ever. The only issue I had was bleeding more than normal when getting scratched and scraped. At first, it was just annoying. Small wounds looked worse than they were. I then had a couple of more serious cuts that really got messy as I finished my rides while pushing it, which of course increased the blood flow through the wounds. Nothing near life threatening, but I did toss my socks as they were soaked with blood from shin wounds by the time I finished riding. My cardiologist took me off of coumadin and said the befit of continuing my riding (the exercise) outweighed the benefit of the thinner _*in my case*_. He wasn't so much concerned about scraps and scratches as he was about potential internal wounds once he had a better understanding of how and where I ride (used a couple of my GoPro vids of rock garden and jumping runs to help explain).

*DISCLAIMER : **Do NOT under any circumstances use anything I stated above to make any decision about whether or not to change any prescription your doctor prescribes you!*


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## fos'l (May 27, 2009)

nOOky said:


> I was on coumadin for many months back in the day, and later Pradaxa. I did not stop doing anything, but you have to be aware that there are some serious side effects. I think the biggest worry was a big hit from a fall. Even a large gash that looks scary will probably be controllable if you can seek medical help. But smacking your chest or your head and not realizing there may be internal hemorrhaging is a big worry. If you suffer a nasty fall it's best to get checked out, regardless of how you think you feel.
> 
> Not sure about Xarelto as I wasn't on it, nor if the bleeding can be reversed like with coumadin.


I'm pretty sure that rat poison (Warfarin, Coumadin), a Vitamin K poison, is the only routinely-prescribed med that can be counteracted, although I'm not sure about heparin or aspirin. You need to be diligent when riding in order to minimize contact with the ground or other obstacles and as above get to the ER if you fall hard. This is my knowledge and do not use for anything but general interest as it's from someone who is not a doctor!


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## Phil Forrest (12 mo ago)

After I began coumadin treatment for a 3 foot clot from my ankle to my groin I stopped biking and just walked everywhere. The clot was not a DVT but a complete occlusion of the greater saphenous vein with a risk of breakage and then PE. Since I live in Philly and commute on bike, I had to start walking and occasionally taking the bus. I've been hit enough times (doors, sideswiped by SEPTA buses, sideswiped by cars, people running stop signs) that I didn't want to risk a cerebral hemorrhage so I just stopped riding. I was working as a therapist in a stroke and spinal injury rehabilitation hospital at the time, so I knew the risks and what a catastrophic outcome could look like. I didn't begin cycling again until months later, after my course of coumadin was finished and I had been cleared by a doc reading an ultrasound.
If I were on a long-term or lifelong course, I wouldn't quit cycling but I'd have to seriously adjust where and how I ride.

Phil Forrest


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## Curveball (Aug 10, 2015)

oldcolonial said:


> Hi Sports fans, wondering if I can get some wisdom from the crowd.
> 
> Recently, I found myself in a rather scary health situation. I ended up in the hospital with several pulmonary emboli. I was feeling kind of crappy, had been for a number of weeks, noticing that my resting heart rate was going up, up by 25 bpm, and that I had no stamina at all and was easily out of breath. On a particular day it got noticeably worse, to the point where it felt like I might imagine drowning does. A couple of days later I went to see my doc and he sent me straight to the ER where the kind folks there said " we have seen cat scans like your's before, but we have never talked to any one that had one". This was their not so subtle way of telling me that I was lucky to still be among the living. All those years of hard training paid off I suppose in the form of a more robust than average cardiovascular system. This whole experience was also an important reminder that rule number 5 should not be followed absolutely. Sometimes, if you feel like crap, its not that you are getting soft but rather that there is something wrong that needs to be addressed.
> At any rate treatment protocol for the emboli is an extended period of a fairly high dose of anti-coagulant medication to prevent the current emboli from growing and or being joined by others while my body's natural garbage collection does the work of clearing the clots. I have seen marked improvement in how I feel after just 3 weeks of treatment and am starting to think about sporting endeavors, including mountain biking again. Initially, the treatment was at the hospital in the form of a heparin drip along with blood tests every 6 hours to get the dosing right, then just shy of three weeks of 2 x 15 mg per day of Xarelto, and now 20 mg per day for the next 2 to 12 months with the potential for a lifetime prescription. Expected value is 6 months though, just enough to take me through to the other side of the peak local mountain biking season.
> ...


I can't offer any advice on the biking, but my sister almost died last week from the same thing. What an incredibly scary thing to go through.

Take care of yourself!


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## chazpat (Sep 23, 2006)

I've had a dvt twice and now I'm permanently on Warfarin, have been taking it for around a decade now I think. I have a protein S deficiency factor 2, which makes me susceptible to clots. I seem to do really well on the Warfarin, my dosage has remained the same for all this time once they initially got it dialed in so I only get it checked every three months, or maybe it's six. I don't have bleeding problems. I crashed into a ditch a couple of years ago breaking four ribs, a scapula and a clavicle and received a few stitches in my head; my helmet did its job. But as nOOky said, a concussion or other internal injury could be very, very bad and I try to remember this, though I hit my head a lot more the last couple of years than I should have. I was really mad at myself the last time, telling myself I really can't be doing that. I don't do a lot of jumping or high risk riding; I just need to take the corners a little slower as that's where I've wrecked the last couple of times. 

But all of this is different; you're talking about different medicine taken for a different reason in a different body. Especially since it is temporary, I would dial it back a good bit if I were you.


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## oldcolonial (Aug 28, 2018)

Curveball said:


> I can't offer any advice on the biking, but my sister almost died last week from the same thing. What an incredibly scary thing to go through.
> 
> Take care of yourself!


 Thank you, Yes, quite a scary situation. I don't think it has fully sunk in yet.


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## Velobike (Jun 23, 2007)

oldcolonial said:


> Hi Sports fans, wondering if I can get some wisdom from the crowd.
> .....
> Thank you in advance for your perspectives.


I'm not sure if what I say could be regarded as wisdom, so starting from that:

I've been ambulanced to hospital twice because of pulmonary embolisms, both following long distance flights in castle class from Australia to the UK.

The first time was 2006 and I spent a few days in intensive care followed by a week in the cardio ward on oxy for most of it. I felt right as rain afterwards. I refused to go on to continued medication afterwards and continued life as normal.

The second time was in 2009 when I was 64. I got the impression they were surprised that I had been able to breathe at all. Once again I was in intensive for about a couple of days, and then I was wheeled through to the cardio ward and again with oxy.

When I was due to be released I asked the consultant if it was ok to exercise riding my bike. When he gave the go ahead I asked if hard exercise was ok. He said I should be good because my heart was in very good condition.

Something on my expression must have given me away because he was about to terminate the interview when he asked what exactly I regarded as hard exercise.

When I told him I had a 24 hour solo mtb race due in 4 weeks time (in the middle of winter) he spluttered a bit, but said while he couldn't recommend it, he couldn't think why not based on my general health.

I spared him the details that I ride these races on a rigid singlespeed, don't want to give them TMI after all. 

I rode the race through snow, ice, and blizzard conditions (my avatar is me approaching the finish) and felt perfectly ok, i.e. no more destroyed than usual after 24 hours on the bike.

However have been on medication ever since, first Warfarin and latterly Coumadin.

The long and the short of it is listen to your body.

However I do recommend avoiding unnecessary risk because one misjudgment may end your riding career.


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## celswick (Mar 5, 2020)

I had a heart attack and three stents installed last summer. I take aspirin and Prasugrel every day now. I haven’t noticed any ill effects other than I get some weird bruises at times for apparently no reason. I get normal cuts and scrapes and they don’t bleed tremendously. They stop bleeding quickly and heal up normally. 

I told my cardiologist I was signing up for a 5 hour mountain bike race and he said that he encouraged all physical activity, but told me to stop taking the blood thinner a couple of days before the race since the long period on the trail would mean I’m more exposed to the chance of crashing. 


Sent from my iPhone using Tapatalk


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## Bikeworks (Sep 10, 2020)

ER RN in a Level 1 Trauma center, and by far the most frequent mechanism of injury for activation of any trauma is a fall on an anticoagulant/antiplatelet. The risk of a subdural or subarachnoid hematoma while on either class of medication is very real. As with all things, consultation with your doctor, along with a personal risk assessment, are all you can rely on when making these decisions. 

@nOOky I have a particular loathing of patients on Pradaxa; seen what seems to be more than a fair share of spontaneous GI bleeds.


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## Spec44 (Aug 17, 2013)

Got a stent 12 years ago, put on a blood thinner as a result. Also had started MTBing again during that year. Was certainly worrisome, as I ride alone alot, and out in the National Forest (nobody would find me for days probably). Even bruises from small falls were scary. Talked to the doctor about it at my 1 year post-stent appt, and he took me off the blood thinner.

I'm still on a 325mg daily aspirin. When I get cut it really flows, but it'll start to clot after a minute, and then it clots really well. Bruises are still obnoxiously large and dark. And I carry an inReach Mini.


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## mudflap (Feb 23, 2004)

Not on blood thinners, but take a daily oral chemo drug that reduces my platelet count. That results in diminished clotting. If I get cut, I bleed for about five minutes before it stops, and that's with lots of intervention, like direct pressure and elevation. I think about more serious repercussions from a serious fall, but have survived so far - knock on wood. Will continue to live life without thoughts of "what if?"


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## sandyeggo (Mar 6, 2011)

I'm a lifer. Factor V leiden (body prone to clotting), diagnosed after having a larger clot in my lower leg up past the knee. I too, avoided going to the doctor - my calf hurt and was swollen - but I chalked it up to riding. My wife went to WebMD and diagnosed me with a blood clot and I didn't believe her. She hounded me enough to the point where I eventually went to the doctor who also didn't think given my age and activity level that I had a clot but sent me right over to get an ultrasound to be on the safe side. And sure enough, I had a clot. They immediately put me on heperin (got to shoot myself in the stomach for a week), then to coumadin (could never get the dosage right), and I've been on Xarelto for 5+ years now. On a side note, Xarelto isn't cheap and has eaten into my bike budget.  

I've not had any issues and never think about being on a blood thinner (although I don't do a lot of jumping). I don't have any issues bleeding a lot when I get minor cuts but I do bruise much easier and harder falls results in ugly bruises. My doctor ok'd the mountain biking but preferred I stay away from the road (getting hit by a car > hitting a tree, apparently). As others have mentioned, he said if I have a hard fall, particularly to the head, that I should get checked out.


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