Contact Sports

[Guest]

I had a St Jude's mechanical valve installed during the summer. Prior to surgery I was a keen Gaelic footballer. Gaelic football is an Irish sport, it wouldn't be as rough as rugby/American football but I have broken my nose a few times, my arm, collar bone and have received a few black eyes. Now that I feel back to myself I would love to go back to my sport but I have been advised not to by Doctors. I know with warfarin the tag line is 'don't do contact sports.' But how dangerous is it?
Some doctors I have asked have been adamant that I shouldn't go back while others have just said 'you probably shouldn't.' Gaelic football is at the centre of the community here, our whole locality revolves around, its very hard not being involved anymore.

Wondering if anyone was in a similar situation? and is doctors advise sometimes overly cautious?

 

[NewbieSlo]

I do not have any similar experience - to start with I did not have the surgery (yet) and I do not play contact sports. I do hope that someone more knowledgeable comes forward but what I was thinking is: could you take on a role that would allow you to stay involved but not play? Like being a referee, coach for the children, take part in organizing games? I do feel that that would be much safer for you.

Anyway, welcome aboard and I'm glad to hear, that you feel "back to yourself".

 

[tom in MO]

The way warfarin works is that it increases the clotting time by a multiple equal to your INR. So if you have a St. Jude and are running an INR at 2-2.5 (like me) it will take your blood 2 to 2.5 times longer to clot. That means your bruises will take longer to stop bleeding and thus will be larger. If you get internal cranial bleeding from a concussion, the amount of bleeding will be about 2.5 times more. That's probablly the big risk. Warfarin should not affect the way you heal, except bruises are bigger and will take longer to go away.

You won't get many doctors who will agree to a sport with a risk of head trauma if you are on an anticoagulant. Sports with significant head trauma risks are a reason some chose a tissue valve. Can you wear a helmet? If you wish to play, maybe there is a position that has a minimal risk of head trauma.

 

[The Thief]

I'm a rock climber and the docs tell me to stop that activity. I continue but I wear a helmet. They are always very concerned about bleeding, especially in the head or abdomen. a concussion could be bad. a cracked head could be fatal. I continue my activity understanding the risks while taking the right precautions. The injuries you described however, will be a pain in the *** to sustain while on warfarin.

 

[The Thief]

I'm a rock climber and the docs tell me to stop that activity. I continue but I wear a helmet. They are always very concerned about bleeding, especially in the head or abdomen. a concussion could be bad. a cracked head could be fatal. I continue my activity understanding the risks while taking the right precautions. The injuries you described however, will be a pain in the *** to sustain while on warfarin.

 

[pino458]

Im 27 and play Semi Pro football in Australia ( Soccer ) i am a goal keeper, i also play futsal or indoor soccer 3 or 4 times a week even after my operation... i am careful of my head but apart from that i dont hold back, i am yet to see any brusing other then what i would expect from a hit or a fall ( very rare ) just becareful of your head.

 

[Agian]

Very inspiring Pino. I assume you've had your valve replaced.

 

[pino458]

Agian, Yes i have... been nearly 2 years now!... still doing everything i was before the operation.. just a little more aware of dangerous situations and have managed to adjust my game to avoid as many dangerous situations as possible

 

[Patsman07]

I am actually the OP on this thread, sorry I just didn't log in when I posted it. As an update- I haven't played any gaeilc football since my original post, although I am still desperate to get back playing. I have spoken to someone who had a mechanical valve installed and did play for one more year afterwards with no ill effects. My first child was born last October and obviously that is a major reason why I never went back playing.
Nevertheless the yearning to go return to my teammates is very strong, although I have tried coaching this season, I can categorically state that nothing compares to playing. It would seem to me that the risk of internal bleeding is rather slim, but I wonder has anyone broken bones while on warfarin? And if so were there any major complications?
I suppose I should be grateful that the only thing that worries me now is the fact that I can't play football, whereas last year pre-op I was very scared and anxious about surgery. Altogether this is a far nicer place to be, but I have an unfortunate habit at looking at the downsides. 'A pessimist is an optimist with experience' as someone once told me.

 

[Patsman07]

I am actually the OP on this thread, sorry I just didn't log in when I posted it. As an update- I haven't played any gaeilc football since my original post, although I am still desperate to get back playing. I have spoken to someone who had a mechanical valve installed and did play for one more year afterwards with no ill effects. My first child was born last October and obviously that is a major reason why I never went back playing.
Nevertheless the yearning to go return to my teammates is very strong, although I have tried coaching this season, I can categorically state that nothing compares to playing. It would seem to me that the risk of internal bleeding is rather slim, but I wonder has anyone broken bones while on warfarin? And if so were there any major complications?
I suppose I should be grateful that the only thing that worries me now is the fact that I can't play football, whereas last year pre-op I was very scared and anxious about surgery. Altogether this is a far nicer place to be, but I have an unfortunate habit at looking at the downsides. 'A pessimist is an optimist with experience' as someone once told me.

 

[Patsman07]

I am actually the OP on this thread, sorry I just didn't log in when I posted it. As an update- I haven't played any gaeilc football since my original post, although I am still desperate to get back playing. I have spoken to someone who had a mechanical valve installed and did play for one more year afterwards with no ill effects. My first child was born last October and obviously that is a major reason why I never went back playing.
Nevertheless the yearning to go return to my teammates is very strong, although I have tried coaching this season, I can categorically state that nothing compares to playing. It would seem to me that the risk of internal bleeding is rather slim, but I wonder has anyone broken bones while on warfarin? And if so were there any major complications?
I suppose I should be grateful that the only thing that worries me now is the fact that I can't play football, whereas last year pre-op I was very scared and anxious about surgery. Altogether this is a far nicer place to be, but I have an unfortunate habit at looking at the downsides. 'A pessimist is an optimist with experience' as someone once told me.

 

[pellicle]

Hey Pat

Congratulations

As has been said every time on every thread that asks this question: of you have a fracture you have more worries than INR. You do not suddenly spontaneously bleed to death unstoppably when you are on ac therapy.

If you keep your INR under control yourself and keep yourself on the 2 side of 2.5 before a match I am willing to bet you just won't notice any difference.

Do you self test?

Your questions seem to suggest you don't yet feel in control. When you self test AND document AND go through some what if scenarios for real then you'll stop worrying and start knowing

Would you go out on the field without doing any practice? Same thing...

PS don't aim for broken bones ... its no fun as you get older.
Glory is temporary - injuries are forever.

 

[Patsman07]

I have always been within range and my INR seems very stable. What is a/c therapy?
Have slipped and hit my head on a wall quite hard already with no repercussions but going into something that necessarily involves contact is still a big decision. When you say you have more to worry about with a fracture, what do you mean?

 

[pellicle]

Hi

What is a/c therapy?

Anti Coagulation Therapy ... warfarin is a tool to modify your bloods tendency to clot. The way we express how much anti clotting (anti coagulation) is the number INR.

Warfarin does not thin the blood (which implies viscosity or dillution, it is an anti coagulant.

When you say you have more to worry about with a fracture, what do you mean?

when I've had a fracture it hurt a LOT ... if you have a compound fracture it hurts even more. A friend had a fall in sport and broke both the ulnar and radius in her arm. She has a plate now (and a gap). A compound fracture will worry you a lot, irrespective of warfarin. Coagulation Therapy can be managed around this. One could say in the ER world its management is "old hat".

 

[Patsman07]

Hi



when I've had a fracture it hurt a LOT ... if you have a compound fracture it hurts even more. A friend had a fall in sport and broke both the ulnar and radius in her arm. She has a plate now (and a gap). A compound fracture will worry you a lot, irrespective of warfarin. Coagulation Therapy can be managed around this. One could say in the ER world its management is "old hat".

I've had quite a few fractures, as you can see in the OP. Collarbone was particularly painful. All happened prior to anti-coagulation. If I understand you correctly-a broken bone/fracture while on warfarin is no big deal?

 

[pellicle]

I've had quite a few fractures, as you can see in the OP. Collarbone was particularly painful. All happened prior to anti-coagulation. If I understand you correctly-a broken bone/fracture while on warfarin is no big deal?

wow ... 2 years later

Well yes, but as I said above

A compound fracture will worry you a lot, irrespective of warfarin.

which I don't think translates to "no big deal"

What I understand is that warfarin will bring with it attendant issues but not be "a show stopper" should you want a fracture.
Myself I've not managed one while on warfarin (yet although there have been occasions where I lay there wondering about that pain I was in).

I can't find much actual research but what I do find suggests that controlling bleeding around the time of the fracture will be the crucial issue. What I do find is not specific nor reliable.

I would assume then that the best practice would be to follow what I followed for my recent colonoscopy, which was to cease warfarin and the re-commence later. That is also what I did when I had the (quite invasive injury bleeding intensive) debridements {look that up if you don't know it}.

I have a blog post about what I did and why here: http://cjeastwd.blogspot.com/2017/12...nt-of-inr.html

A point not made there is that Vitamin K therapy (injected) will reduce your INR rapidly but equally your warfarin "float level" (to coin a term) will remain the same till you cease warfarin and wait for it to go down.

Given (if I recall rightly) you're a modern bileaflet carbon valve like me, and that this is your only "clotting related risk factor" I'd say that ceasing warfarin for 3 days (from the break point) would be appropriate.

There would be zero point in "bridging" with heparin because you actually want to restore proper coagulation at the early stages of the break.

So, hopefully you won't need to test this (nor I)

Best Wishes

 

[Superman]

I've had a elbow fracture from playing basketball. Sprained a couple ankles. "Lifted" a toe nail (got rid of that chair). Broke a thumb. Took some spills off my mountain bike. Had a coupe minor operations. Had a second heart surgery. Recently dropped a rather substantial piece of furniture on my foot (that was pretty). I also used to play a weekly game of pick-up American Football at a local school yard after my first surgery. Some guys took some pretty big knocks. We were all playing no pads, no helmets.

All while managing Warfarin.

My breaks weren't any big deal, but they weren't compound and weren't all the way through where any setting or re-breaking was required.

As pellicle points out so well, be an informed and educated patient. One can argue that most of us as heart patients and warfarin patients are given guidance that is probably good advice for even "normal" people. Maybe get a medic-alert bracelet or necklace (I've even seen tattoos), in case you aren't in condition to inform first responders of your medical condition. Playing in a contact sport is risky. Concussions we are learning more and more about, fractures are never good (as pointed out), and nobody is getting any younger as time marches on. I would think playing would be okay, as long as you are smart and more conscientious than you were before.

 

[yotphix]

One key point here, is that Warfarin puts you at greater risk for a subdural bleed, and potentially worsens a bleed vs. not being anticoagulated. That's why we try to avoid getting hit in the head, of course. It also changes how we react when we are hit in the head.
I had my bell rung pretty good at work two days ago. If it weren't for the Warfarin, I would have shaken it off and gone back to the grindstone. Instead, the office insisted I be examined by a medic, who then insisted I be taken to hosipital for further examination. The triage prioritized me (I guess there is a small advantage to being a bit bleedy, it makes a little cut look more serious!) and the emerg resident decided to check INR (2.7 - my range is 2 -3) and then sent me for a CT scan, just to be on the safe side.
I had no intra cranial bleeding, so back to work I went.
Every step of the way, people made different decisions because of the warfarin.
If you do decide to go back to playing, you really must inform the team, the league, the officials and the medics of your ACT, and you really must monitor your INR. I would suggest choosing not to play if you go above range by an amount that would make you change your dose.
I did do a little reading about head injury while I was waiting at the hospital, and it seems like the bleeds are pretty treatable, but only if doctors know they are happening, hence the trouble taken on my behalf.
One thing my cardiologist said when we talked about activities post surgery was 'life is for living'. I took that to heart, and got back to pretty much normal life, with all of the contingent risks. But I do try not to get hit on the head too much!