Question for active Coumadin users

[Ross]

What non-Coumadin users don't know or realize is that you do not bleed like a pressurized hose when cut or whatever. You bleed a tiny bit longer then usual, bleeding is still stopped with direct pressure and that's it. If you are not anitcoagulated and have a major cut or injury, it's dangerous to you too! People need to stop this silliness of separating anticoagulated and coagulated people into two groups, if it's dangerous enough to coagulated folks, it's dangerous for EVERYONE. Too many people have villianized the drug to make it sound as though the tiniest of tiny cut is going to cost you your life and it's simply not true. About 90% of the stuff people are told is no longer or never was true.

 

[Kathleen]

I hope you had a chance to read the story in Newsweek about the woman who climbed Mt Everest after having her St Judes mechanical valve replacement surgery. She is a wonderful inspiration to living life exactly as she did before surgery or as she terms it better.
Kathleen

 

[Bad Mad]

What non-Coumadin users don't know or realize is that you do not bleed like a pressurized hose when cut or whatever. You bleed a tiny bit longer then usual, bleeding is still stopped with direct pressure and that's it. If you are not anitcoagulated and have a major cut or injury, it's dangerous to you too! People need to stop this silliness of separating anticoagulated and coagulated people into two groups, if it's dangerous enough to coagulated folks, it's dangerous for EVERYONE. Too many people have villianized the drug to make it sound as though the tiniest of tiny cut is going to cost you your life and it's simply not true. About 90% of the stuff people are told is no longer or never was true.

Given what you said Ross, where do You think the line should be drawn?
My passion is a contact sport, that involves quite alot of bodily contact. You may get the odd gash on the head from an accidental collision, a dead leg, thump on the chest etc.

All the info. I have been given from docs has been when/if you go on warafrin NO WAY for contact sport. If say, competitive soccer or American footy was your passion, what would you do??

 

[MarkU]

Just out of curiosity, can anyone cite a documented example of a serious or fatal sport injury that was made worse specifically because the person was on anticoagulation therapy?

I would imagine it's about the same as the number of people on Coumadin who have bled to death in dentist's chairs...



Mark

 

[Ross]

Given what you said Ross, where do You think the line should be drawn?
My passion is a contact sport, that involves quite alot of bodily contact. You may get the odd gash on the head from an accidental collision, a dead leg, thump on the chest etc.

All the info. I have been given from docs has been when/if you go on warafrin NO WAY for contact sport. If say, competitive soccer or American footy was your passion, what would you do??

Well some of what you mention, I wouldn't do, but others would. I guess it comes down to how much you wish to restrict your own life. If you take as much precaution as possible, I see no reason not to go on and live the life you love. You do have to watch bashing you head in, but lets face it, if you hit it hard enough to cause a bleed, even coagulated people are going have problems, yours would be multiplied because of the longer bleeding times.

 

[Ross]

Just out of curiosity, can anyone cite a documented example of a serious or fatal sport injury that was made worse specifically because the person was on anticoagulation therapy?

I would imagine it's about the same as the number of people on Coumadin who have bled to death in dentist's chairs...



Mark

Good point Mark, I have a feeling your dead on right too.

 

[Karlynn]

Just out of curiosity, can anyone cite a documented example of a serious or fatal sport injury that was made worse specifically because the person was on anticoagulation therapy?

I would imagine it's about the same as the number of people on Coumadin who have bled to death in dentist's chairs...



Mark

You bring up something I've always wondered. We are always hearing about how warfarin is dangerous if you're very athletic, but I've never seen any stories about people actually dying because they received a sports-related injury while on warfarin.

And if there are stories - how many are there? One story doesn't mean that there are thousands.

 

[PeggyM]

They act like we're dumb as hell and fragile as china don't they?!

My advice? Live your life the way you want. If contact sports is your thing than don't let a drug stop you! Just stay on top of your testing and make sure you're in range. My biggest injury/bleed occurred because I wasn't getting tested frequently enough (no insurance at the time) and I ran into major trouble.

 

[SumoRunner]

What I was told was that what they worry about is not bruised muscles but certain internal organs or a blow to the head. There's the possibility that a few small vessels in the brain could hemorrhage and form a clot. That could result in a "stroke" by blocking a critical function. Or pooling of blood in and around an organ that would impair it's function.

I had one such TIA 20 years ago, 4 years prior to the valve replacement. It was caused, so I was told, by the defective valve flicking off a chunk of plaque or a clot that would have formed in the eddies of the leakage. The chunk coursed around the blood stream and eventually lodged in the speech center. I was unable to speak or write for several hours. But I was able to open the combination lock at the gym, took a shower and drive home. Other than speech I was able to function normally.

And why, you ask, did it decide to lodge in the brain and not the big toe for instance? Well, perhaps on other occasions it had. It turns out the big toe is a bit less critical to cognitive functions than many parts of the brain.

So, as long as there's little danger of blows to the head or damage to internal organs which would require some pretty major contact, you're OK. I've felt safe in running, weight lifting, shot put and discus. None of those are contact sports though.

 

[Lynlw]

I was wonderring, if any of the coumadin users doctors reccomend periodic bones scans? I was thinking of it in this thread particularly, since it might be something for active people to ask about, incase there is a problem it could be caught early. I think from what I read, men are the ones whose risk of osteoporitis can go up from long term coum.

 

[Kathleen]

I just had a bone scan and it came out with no osteo whatsoever and I have taken coumadin for 22 years. The scan was done because of my age

 

[mntbiker]

I was wonderring, if any of the coumadin users doctors reccomend periodic bones scans? I was thinking of it in this thread particularly, since it might be something for active people to ask about, incase there is a problem it could be caught early. I think from what I read, men are the ones whose risk of osteoporitis can go up from long term coum.

That is correct. I no longer have the study with the numbers but it was found that the increase in risk is not statistically significant.

 

[Bad Mad]

It sounds like to me that recreational competitive sport is probably ok, where contact isn't that robust. I was told when I got my homograft implanted, if you go for mechanical valve, contact sport is out. As you say Ross it's personal choice but I suppose when you are actually on warafrin you get a better feel for the do's and don'ts??

I know this question has been debated before but I'm not sure if we ever agreed on an answer. Can anyone see a reason for not exercising to your Max HR with a mechanical valve implanted??

BTW: I have never heard of a sporting catastrophe re: warafrin, but then again how many people on warafrin are actually taking part in competitive (contact) sport? Probably not that many.

 

[67walkon]

Part of my decision to have a tissue valve rather than a mechanical valve was coumadin. I understand what you guys are saying. I respect it. But, there is a risk of closed head injury from a header while bike riding. That risk is higher on coumadin than it is without coumadin. The risk of internal bleeding is measurably higher, and while I appreciate the fact that one cannot let these conditions control one's life, eliminating that risk was an important consideration to me. I have suffered two diagnosed and probably a third concussion in my life and no matter what anyone says, the risk of additional or worse injury is there for coumadin users.

Today my cardilogist took me off coumadin. I had been riding my bike for a few days anyway, knowing and accepting whatever additional minor risk there was. I am happy to be off it, although I know I could still have a cerebral hemmorage or other issue, but confident my risk is lower.

Even with apirin, there is some increased risk. I know guys that quit taking a daily aspirin because of that risk, but I view it to be a worthwhile risk in the overall scheme of things.

Also, if I have to go back on it or if I wasn't taken off it, I would have followed your advice. I would have continued doing what I really like to do, monitoring the levels carefully and doing what I could to avoid injury. Life offers us fleeting opportunities to do what we love doing, and a stupid med shouldn't stop us.

Stepping off my soap box, I remain your friend. John

 

[MarkU]

Just to be clear, the risk of incurring a closed head injury has absolutely nothing to do with whether you're on Coumadin.

If you do incur a head injury bad enough to cause intercranial bleeding you've got problems, Coumadin or not.

Again, as I asked before, can anybody show me any documented proof that Coumadin really makes such an injury worse??? Yeah, you're going to bleed a bit longer, but your blood still will coagulate and stop bleeding. Being on Coumadin does not mean that you're a hemophiliac.

Does anyone know how much naturally-occuring variation there is with INR levels? Should we be screening participants in contact sports to see if their 'normal' INR is >1.0, and banning them if it is?

Mark

 

[Lynlw]

Just to be clear, the risk of incurring a closed head injury has absolutely nothing to do with whether you're on Coumadin.

If you do incur a head injury bad enough to cause intercranial bleeding you've got problems, Coumadin or not.

Again, as I asked before, can anybody show me any documented proof that Coumadin really makes such an injury worse??? Yeah, you're going to bleed a bit longer, but your blood still will coagulate and stop bleeding. Being on Coumadin does not mean that you're a hemophiliac.

Does anyone know how much naturally-occuring variation there is with INR levels? Should we be screening participants in contact sports to see if their 'normal' INR is >1.0, and banning them if it is?

Mark

I don't know if you are being sarcastic with your second question, but the there are quite a few articles from studies if you look for "coumadin closed head injury" on the pubmed site
I'm not sure if this link will work because it was longer than my address space,
http://www.ncbi.nlm.nih.gov/sites/e...ez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

if not I'll copy a short one BTW being 47, I was surprised to see in some of the articles elderly is over 55 to be fair, one of the studies I read, found no difference, but most of them were close to this

Franko J, Kish KJ, O'Connell BG, Subramanian S, Yuschak JV.
Department of Surgery, Abington Memorial Hospital, Abington, Pennsylvania 19001, USA. [email protected]

BACKGROUND: A large population of patients on oral anticoagulants is exposed to the risk of traumatic brain injury (TBI). Effects of age and anticoagulation on TBI outcomes need to be assessed separately. METHODS: Retrospective analysis of consecutive series of TBI patients (age 18 years and older) in a suburban teaching hospital. RESULTS: A total of 1,493 adult blunt head trauma patients between January 2001 and May 2005 were analyzed. Of these, 159 patients were warfarin-anticoagulated at the time of trauma. The mortality in anticoagulated patients was statistically significantly higher than in the control group (38/159, 23.9% vs. 66/1,334, 4.9%; p < 0.001; odds ratio 6.0). Mortality of patients over 70 years of age was significantly higher than in the younger population (p < 0.001). Both mortality and the occurrence of intracranial hemorrhage (ICH) after head trauma were significantly increased with higher INR (Cochran's linear trend p < 0.001), especially with INR over 4.0 (mortality 50%, risk of ICH 75%). Preinjury warfarin anticoagulation and age were found to be predictive of survival in a binary logistic regression model (92.5% correct prediction, p = 0.027). Addition of Injury Severity Score and initial Glasgow Coma Score to this model only modestly improved its predictive performance (95.4% correct prediction, p < 0.001). CONCLUSIONS: Both age and warfarin anticoagulation are independent predictors of mortality after blunt TBI. Warfarin anticoagulation carries a six-fold increase in TBI mortality. Age over 70 years and excessive anticoagulation are associated with higher mortality, as well.

PMID: 16832256 [PubMed - indexed for MEDLINE]

 

[Karlynn]

Head injuries are not a good thing and, yes, being on Coumadin will make a difference. Other bleeds that can be reached without sawing away at bone are not quite as big a concern. The way it was explained to me is that often anyone suffering a head injury that causes bleeding in the brain they must just wait and hope the bleeding stops before other measure are taken (if they can be taken). Factor in Coumadin and the area will bleed longer, so waiting for it to stop is also a longer process, causing more swelling and more pressure on the brain. This, in turn, is not good, to put it simply.

To what degree the risk is increased - I don't know. I'm sure some of that depends on what the INR is at the time of the incident and how quickly measures are taken to bring down the INR.

The over-all problem with head injury resulting in bleeding is that measures to stop it are more complicated and time involved.

 

[mtkayak]

I asked my Card about internal bleeding as well (not brain hemmorage) and he simply said "It will stop".

I have, what I think, to be a hemmroid. Well, I saw blood in my stool for about 5 days. I started to worry about it and almost went to the doctor. But I was feeling no ill effects from it. I decided not to go. Guess what? It stopped! I'm fine now, stool is back to normal. End of story, Coumadin not a big deal.

I hit a rock with my elbow HARD last week while kayaking. Got a big goose egg on my elbow. Busted a blood vessel, it swelled up, now it's gone down. Just a bruise to show for it. I didn't even put ice on it, just let it heal by itself. Not a big deal.

A brain bleed is bad news for anybody, Coumadin or no Coumadin.

 

[67walkon]

Lyn, thank you for the documentation. The answer appears to be a 4 to 5 times greater mortality risk from head trauma as a result of being anticoagulated with wayfarin.

That doesn't mean coumadin should stop you from doing things. If you are aware of the risk and take the precautions you can take, you can make an informed decision. I made an informed decision to take the risk when I was on coumadin recently and in the past. On the whole, I prefer not to take that risk and am happier without coumadin. If I had to take it all the time, I suspect I would accept the risk.

John

 

[mtkayak]

It amazes me how people sit around and toss around statistics and calculate mathmatical eqautions that sometimes equal less than 1% percent. It amazes me how some smokers out live non smoker when they have 3 times the greater risk of heart disease. It amazes me how my grandmother lived to the ripe old age of 93 and ate nothing but lard and a heavy cholesterol diet ALL her life. Accidents rank amongst the highest killer of most of our youth. Did you ever think if it your time to go, then it's your time to go?

Nobody ever gives good old common sense any credit any more.Use your common sense and most of the time you will prevail. Wear a helmet and you'll be fine. Go live life!!!