Question for active Coumadin users

[67walkon]

For any of you people with mechanical valves who are riding bikes or doing anything similar, has anyone quantified the risk of cerbral hemorrage from a head blow?

I know that some guys, like Fast Eddie and others, are riding while taking coumadin. There may be a few weeks when I am otherwise physically cleared to ride again, but still on coumadine as a preventive measure. I've heard that I may be on it for 2 months, 3 months or as much as 6 months, and it is kind of difficult to pin them down.

The main reason for the coumadin with me is a history of atrial fibrillation. I got a maze procedure to fix that and left the surgerical hosptial without being on coumadin. I had an afib episode at home and the local doc put me on coumadin. Now, it has been a bit over a month since I had any afib issues, but I've heard anything from the 2 months to 6 months after surgery for being on coumadin.

I don't much care except for the fear of doing a header and having intercranial bleeding. That was one of the reasons I insisted on a tissue valve in the first place.

So, for you guys or girls brave enough to ride while on coumandin, has anyone quantified this risk for you? Is the risk low if your INR is in 2 to 2.5 range?

And if no one has quantified the risk, do you have a plan if you should do a header?

But for the coumadin, I think I otherwise cleared to ride as of Saturday, September 1 and I have really been looking forward to it. But my next cardio appointment isn't until the next week. Right now, I will probably risk some easy, careful rides and then discuss it with the cardio after the fact.

Thanks for any input.

John

 

[Ross]

Well hopefully your wearing a helmet and if your not, Coumadin or not, whacking your noggin into something would most likely cause an intracranial bleed. YOU ARE NOT AN EGG! Put your helmet on and ride on brother. Sounds to me like you bought into a bunch of Coumadin misinformation.

 

[67walkon]

I always wear a helmet! In May, I think it was, I saw a guy do a header without a helmet. I called 911; fortunately, he did not have a bad head injury, but he did bleed quite a bit.

Ross, is there any information on this? The issue as I understand it is bleeding inside the skull, even with a helmet.

I'm probably going to do it, because the last time I went over the handlebars was probably 20+ years ago. But I did get a nasty concussion from a bike accident when I was a kid, so it does happen.

Thanks, John

 

[Philip B]

Cycling

Cycling

Hi John,

I engage in bicycling (both road and mtn) on a daily basis. My aortic valve was replaced with a St. Jude mechanical in March of 07. I maintain a INR range between 2.5 & 3.5.

Since returning to cycling after surgery I've become more aware of wearing my helmet, but I have not let coumadin issues slow me down much. Several weeks ago I survived a pretty nasty tumble while mountain biking. I rode away after re-setting three dislocated fingers. The scrapes on my legs have pretty much healed and my bruises are fading. I did examine my helmet closely for any kind of impact damage after the wreck. Had the helmet been damaged, I would have replaced it.

Opinions may vary, but I personally feel those of us who take coumadin need not avoid engaging in the activities we enjoy. Make use of the protective equipment that is typically recommended for the activities you wish to do and enjoy yourself. Wearing a helmet simply makes sense for everyone who engages in bicycling because no one needs to tempt fate by risking brain injury with head trauma.

My wife insisted that I start wearing a helmet while skiing last year before we learned that I needed AVR surgery. It simply made good sense.

-Philip

 

[catwoman]

67walkon:

I have a Trek comfort bike and have gone back to using it, riding almost every day. I **always** wear a helmet. Feel nekkid without it! I wear my Medic-Alert bracelet and attach my cell phone to the bike cabling, use my BlueTooth.

Our home is in a semi-rural area, lots of gravel on the shoulder, no sidewalks. Lots of opportunity to take falls. So far, so good.

Nowadays, just about everyone who rides a bike has a helmet. That wasn't the case years ago.

A friend who is a regular on organized rides (done the Hotter 'n' Hell in Wichita Falls TX twice) says she's come across several bikers who are mechanical valvers and are on warfarin.

 

[catwoman]

Just thought of this concerning cerebral hemorrhages:

I work at a newspaper. We have a link to the county medical examiner's office. I peruse the listings almost every day.

They don't always list a cause of death. However, I occasionally see causes due to athesclerotic disease, suicide, motor vehicle accident, on-the-job accidents -- and cerebral hermorrhages from "SHORT FALL" -- usually a very elderly person in a nursing home.

About 5 years ago, we ran a news story about the death of a man who owned a golfing range. Someone decided to club him to death (with golf clubs). The man was on warfarin. Yes, he died of a cerebral hemorrhage, but he would have done so regardless. He was alone at the time, was not found for an hour or 2. It was very tragic. I can't remember if the killer was found.

 

[Ross]

I always wear a helmet! In May, I think it was, I saw a guy do a header without a helmet. I called 911; fortunately, he did not have a bad head injury, but he did bleed quite a bit.

Ross, is there any information on this? The issue as I understand it is bleeding inside the skull, even with a helmet.

I'm probably going to do it, because the last time I went over the handlebars was probably 20+ years ago. But I did get a nasty concussion from a bike accident when I was a kid, so it does happen.

Thanks, John

John in most all cases, brain hemorrhages are seen in the elderly. I honestly can't think of a single one for younger people. I've whacked my head into the car door frame a few times now. I'm talking bleeding external injury to the cranium and no internal damage done. This is why I say your not an EGG. These misinformation propagators love to point to such things, but fail to mention what age bracket the studies were from. On another note, if your not taking safeguards to guard against injury, your likely going to suffer an internal bleed whether or not your on Coumadin and believe it or not, some injuries that get reported such as this end up as a stat only because the person answered yes to being on Coumadin, not that it would have mattered anyhow.

 

[Ross]

Well, you're not talking about riding a motorcycle without a helmet. I imagine you aren't talking about doing BMX stunts either. One always has to balance quality of life issues with taking care of oneself and using good common sense.

There is some risk of serious injury in riding a bike, even if you are not on coumadin. How much greater is the risk on coumadin? If you avoid having an accident in the first place, there is no increased risk of having a brain bleed at all. So ride prudently, and try not to wreck. You might not be able to be quite as macho as you would otherwise want to be, but I bet you can ride a bike, stay in shape, have fun, and feel good about it.

Rachel does this apply to people like me that run smack straight on into signs?

 

[Ross]

It depends on how fast you are going when you hit the sign, as well as whether you can hit it every time.

Last time I got on my ten speed (yes, years ago) the damn tire got stuck inbetween the sidewalk and edging. I didn't get it out in time and smacked straight into a stop sign. On another occasion, same thing happened only in a trailer park and I smacked right into the side of a guys trailer. Old man thought I knocked it off it's foundation and boy was he mad. Wasn't a darn thing I could do about it though.

 

[Cooker]

Last time I got on my ten speed (yes, years ago) the damn tire got stuck inbetween the sidewalk and edging. I didn't get it out in time and smacked straight into a stop sign. On another occasion, same thing happened only in a trailer park and I smacked right into the side of a guys trailer. Old man thought I knocked it off it's foundation and boy was he mad. Wasn't a darn thing I could do about it though.

So, did you get to meet a Trailer Park Queen?????

 

[67walkon]

It sounds like you need to be a little careful, stay out of groups or pace lines, and try not to fall.

It should only be for a few relatively short, slow rides, so I think I will risk it.

Anyone who rides a bike without a helmet, coumadin user or not, is crazy.

Thanks.

John

 

[briansmom]

Being an off-road motorcycle rider and racer for most of my life, I look at those little bicycle helmets and laugh. A lot of mountain bikers that I know wear their full face motorcycle helmets when they ride their mountain bike. I make my son wear his motorcycle helmet in his fully caged off-road vehicle. Better safe than sorry, but you still have to have fun!!

 

[Ross]

Ross --
So, you're two for two on hitting obstacles?

With those crappy thin 1 1/4" ten speed wheels, yes!

 

[Ross]

It sounds like you need to be a little careful, stay out of groups or pace lines, and try not to fall.

Actually no, it sounds like someone being way over cautious. Honestly your not going to fall apart like humpty dumpty. Someone has spooked you but good.

Robthatsme is still using chainsaws, I'm still cutting myself silly working on cars and there are others doing equally dangerous things while on Coumadin.

 

[MarkU]

My cardiologist is supportive of my triathlon training. He cautions me to always wear a helmet, but doesn't assign any more risk to it because of being on Coumadin (2.5-3.5 INR). He feels any impact great enough to cause intercranial bleeding is probably going to be a big problem, Coumadin or not.

I had a big crash on my bike last year. Was doing just over 20 mph when I hit a patch of sand and the front wheel washed out.
It all seemed to go in slow motion and one of my vivid memories was my head bouncing off the road as I slid along. The right side of my helmet had a flat spot and a couple of small cracks on the side where it hit the pavement. My right shoulder was sore for a while and I had some nice road rash, but otherwise came through it okay. Tossed the helmet in the trash and traded up to a better (more expensive) model.

Odds are I'll go down again eventually, but it doesn't worry me much.

Mark

 

[PeggyM]

Don't let being on coumadin stop you from living!

Several years ago I was so excited to be at the beach I jumped out of a truck and ran smack into a pole that was hanging out of the back. Wacked my head good. Spent that first vacation night in the ER but nothing happened. Just a big bump.

 

[ruth]

Hey John - I'm like you, on Coumadin for AFib, had a repair so it's not for that.

My perspective is that of moderation and reasonable risk. Yes, I'll continue to ski but maybe my days of mogel jumping are over even before they began . Seriously, maybe I'll upgrade to a nice helmet but I'm not going to waste my second chance at life in fear of tragedy. Those things that form the fabric of our lives, to the extent we can do them and they are important to us, I feel that we should. JMHO.

Peace,
Ruth

 

[Bad Mad]

Apologies for hi-jacking the thread for my own pleasure, but the as some-one who will prob be on comaudin in near future, I find the range of opinions on do's and don'ts fascinating.

I see the opinion on Motor Racing is split. What are people's thoughts on other and in particular contact sports?

Soccer - Potential for clash of heads, a driving knee to the thigh etc.

Rugby- Lots of physical contact to chest, arms, legs etc...

Basketball- Pretty much non-contact.

 

[Philip B]

Split

Split

I might be assuming too much, but I suspect you'll see a lot of split opinions regarding other kinds of contact sports as well. We seem to be a pretty opinionated, diverse group.

-Philip

 

[Magic8Ball]

I assessed the risk of a lot of things after surgery.

Gave up motorbikes and martial arts.

Last weekend i rode down two flights of concrete stairs while out on my mountain bike (wearing a helmet).

Risk vs Pleasure assessment for me.

If i give up everything that can kill me it won't be worth staying alive.

Regards.