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Anybody out there on long term use of warfarin, I am facing heart surgery in the next few months to have my Aorta valve replaced and Mitral valve repaired.
I climb, walk and mountain bike and besides the risk of bleeding following an accident my biggest issue is that I wont be able to use anti-inflamitory tabs (ibruprofen) once on the warfarin.
At 59 my joints and muscles get inflamed after exercise and I like to ease the pain with ibru.and also to treat any injuries and my dodgy knees.
Would be interested if anyone has any suggestions for alternative anti-inflamitories and if long term use (the rest of my life) of warfarin has affected there activities.
Any input appreciated, thanks.
I climb, walk and mountain bike and besides the risk of bleeding following an accident my biggest issue is that I wont be able to use anti-inflamitory tabs (ibruprofen) once on the warfarin.
At 59 my joints and muscles get inflamed after exercise and I like to ease the pain with ibru.and also to treat any injuries and my dodgy knees.
Would be interested if anyone has any suggestions for alternative anti-inflamitories and if long term use (the rest of my life) of warfarin has affected there activities.
Any input appreciated, thanks.
In reply to Todgerman:
The only thing I can think of is Ibruprofen gel. You put in on externally so it has no influence on your internal organs (as far as I understand it).
You would obviously need to ask your GP though, I am NOT a doctor.
Hope you find something that works.
Craig.
The only thing I can think of is Ibruprofen gel. You put in on externally so it has no influence on your internal organs (as far as I understand it).
You would obviously need to ask your GP though, I am NOT a doctor.
Hope you find something that works.
Craig.
In reply to Todgerman: sulphasalazine is what i may have to use to sort my knees out because i cannot take nsaids. my dodgy joints are due to other probs though so not sure if it would be suitable. im sure your docs would give you the best advice.
In reply to Todgerman:
Speak to your doctor, surgeon and ask several chemists for what you can take to stop the inflammation and you should get some ideas. Tell them you are active and want to carry on doing things like long walks so they do listen instead of treating you as knackered at your age.
I take warfarin and so long as your INR tests come out satisfactory you should have no problems, though cuts can bleed a bit more at times.
Do you take glucosamine and chondroitin, it helps some people with joints, did mine anyway. Now I can squat on my haunches and get up again, something I had not been able to do for the last 20 years.
Speak to your doctor, surgeon and ask several chemists for what you can take to stop the inflammation and you should get some ideas. Tell them you are active and want to carry on doing things like long walks so they do listen instead of treating you as knackered at your age.
I take warfarin and so long as your INR tests come out satisfactory you should have no problems, though cuts can bleed a bit more at times.
Do you take glucosamine and chondroitin, it helps some people with joints, did mine anyway. Now I can squat on my haunches and get up again, something I had not been able to do for the last 20 years.
In reply to Todgerman:
I'm due to get my aortic valve replaced at some point, so I'm aware of the issues with warfarin.
There has been a new valve developed by US company On-X. It was certified for fitting as a replacement valve by the FDA in 2001. It currently still has to be used with warfarin, but On-X started a trial in 2005 using it with only plavix and aspirin. This trial will end in 2015. Assuming it's successful I presume anyone who has had an On-X valve fitted would be able to come off warfarin and use plavix and aspirin.
If I were getting a new valve fitted I would be very keen to get an On-X valve. Have you spoken to your consultant / surgeon about this?
I'm due to get my aortic valve replaced at some point, so I'm aware of the issues with warfarin.
There has been a new valve developed by US company On-X. It was certified for fitting as a replacement valve by the FDA in 2001. It currently still has to be used with warfarin, but On-X started a trial in 2005 using it with only plavix and aspirin. This trial will end in 2015. Assuming it's successful I presume anyone who has had an On-X valve fitted would be able to come off warfarin and use plavix and aspirin.
If I were getting a new valve fitted I would be very keen to get an On-X valve. Have you spoken to your consultant / surgeon about this?
In reply to Todgerman: I would advise pro-active use of Glucosamine Chrondoitin, Flaxseed oil or cod-liver oil. As for what anti-inflamatories you could use sorry I'm a nurse not a doctor.
In reply to Todgerman: You can look up the British National Formulary (BNF) website for drugs that can work alongside or against any drug you're on. Its what medics use but as someone else has suggested a good chat with your local pharmacist would be good too.
All the best with the op.
Ryan
All the best with the op.
Ryan
In reply to tri-nitro-toulumne:
Here's some more info about the trail:
http://www.onxlti.com/onxlti-hv-proact.html
Here's some more info about the trail:
http://www.onxlti.com/onxlti-hv-proact.html
In reply to Todgerman:
I've been on warfarin for three years now and not had any problem but that may vary depending on the INR target your doctor sets. Mine's 2.5. I've not even noticed that cuts bleed more than previously. Anti-inflamatories are a problem. My GP has advised me that I can use external gels but only in very localised areas and sparingly. Her view is that the benefits I get from climbing and walking, both in general fitness and in the incentive it gives me to keep at least some of the lard off is worth the extra risk.
I've been on warfarin for three years now and not had any problem but that may vary depending on the INR target your doctor sets. Mine's 2.5. I've not even noticed that cuts bleed more than previously. Anti-inflamatories are a problem. My GP has advised me that I can use external gels but only in very localised areas and sparingly. Her view is that the benefits I get from climbing and walking, both in general fitness and in the incentive it gives me to keep at least some of the lard off is worth the extra risk.
In reply to Todgerman:
http://www.ukclimbing.com/logbook/c.php?i=3415 really good but bold low down and if you do it in one pitch watch your rope choice as I got the world's worst rope drag.
Errr. Don't really know about alternative anti-inflammatories - I tend to avoid them and just use paracetamol / cocodamol and occasionally voltarol gel. But I do know the main problem with such things (as well as all the dietary restrictions) is just how they interfere with the INR readings, rather than any health risks per se. If you eat something "dubious" (e.g. spinach) a lot and regularly, that's okay as long as you keep doing it consistently after you go on warfarin - it's if you keep changing things then it will fcuk up the INR reading. I suspect anti-inflammatories might be the same.
As for the effects of warfarin whilst climbing etc: I get lots of minor bruises on my arse from sitting on rocks etc. And I get pissed off when my INR appointment coincides with a free, dry, day, so I end up missing plenty and having to reschedule, but WTF, INR fits around my life not vice versa. No problems with bleeding etc (this is on 2.5), although I tend to wear a lid a bit more and it's probably recommended to wear one at all times. No effect at all on the ability to CRUSH, SEND, nor be SYKED .
http://www.ukclimbing.com/logbook/c.php?i=3415 really good but bold low down and if you do it in one pitch watch your rope choice as I got the world's worst rope drag.
Errr. Don't really know about alternative anti-inflammatories - I tend to avoid them and just use paracetamol / cocodamol and occasionally voltarol gel. But I do know the main problem with such things (as well as all the dietary restrictions) is just how they interfere with the INR readings, rather than any health risks per se. If you eat something "dubious" (e.g. spinach) a lot and regularly, that's okay as long as you keep doing it consistently after you go on warfarin - it's if you keep changing things then it will fcuk up the INR reading. I suspect anti-inflammatories might be the same.
As for the effects of warfarin whilst climbing etc: I get lots of minor bruises on my arse from sitting on rocks etc. And I get pissed off when my INR appointment coincides with a free, dry, day, so I end up missing plenty and having to reschedule, but WTF, INR fits around my life not vice versa. No problems with bleeding etc (this is on 2.5), although I tend to wear a lid a bit more and it's probably recommended to wear one at all times. No effect at all on the ability to CRUSH, SEND, nor be SYKED .
In reply to Todgerman:
I don't know much about this stuff but the marketing company I work for is promoting a product called Pradaxa which as I understand it is an alternative to Warfarin and is supposed to have less downsides to it than Warfarin.
Don't know how much this will help you or the question you asked but thought I'd mention it.
Do check this out though with your doctor though as I only make some of the website stuff for the marketing of this product so don't really know much about it.
I don't know much about this stuff but the marketing company I work for is promoting a product called Pradaxa which as I understand it is an alternative to Warfarin and is supposed to have less downsides to it than Warfarin.
Don't know how much this will help you or the question you asked but thought I'd mention it.
Do check this out though with your doctor though as I only make some of the website stuff for the marketing of this product so don't really know much about it.
In reply to ElBarto:
I think you'll find Pradaxa is only liscensed for use in AF. Not this situation.
I highly advise speaking to the hospital pharmacist - there is lots of information given in a proper warfarin counselling from a pharmacist. Ensure you ask them about any meds/supplements you're on & and you may like to use as needed.
Be careful looking at supplements - a lot of them also interact with Warfarin, I am aware of at least case repeorts of Warfarin-Glucosmine interactions.
Good luck with the op!
I think you'll find Pradaxa is only liscensed for use in AF. Not this situation.
I highly advise speaking to the hospital pharmacist - there is lots of information given in a proper warfarin counselling from a pharmacist. Ensure you ask them about any meds/supplements you're on & and you may like to use as needed.
Be careful looking at supplements - a lot of them also interact with Warfarin, I am aware of at least case repeorts of Warfarin-Glucosmine interactions.
Good luck with the op!
In reply to Todgerman: Thanks everyone for your inputs and good wishes, very much appreciated. I will look into the suggestions that you have made and do some investigating and seek the advice of a good Pharmacist.
Thanks again !!
Thanks again !!
In reply to tri-nitro-toulumne: Thanks for this link, very interesting I will certainly ask my surgeon about this. Cheers
In reply to Todgerman:
Speak to your surgeon about the type of valve, whether you can have a pig valve and avoid anticoagulation. Or is the warfarin for your mitral valve? What rhythm are you in?
Ask what you target INR will be.
At 59 I would avoid all NSAIDS unless you have very good reason to use them.
Whatever you are doing wear a helmet. intracranial bleeding from trauma is very bad when anticoagulated. Bleeding form other sites can be bad but is more likely to be recoverable. If there is any way to avoid warfarin I would do so. If not then it is a matter of balancing the risk of sports against that of increased bleeding. this is of course very difficult to quantify.
Speak to your surgeon about the type of valve, whether you can have a pig valve and avoid anticoagulation. Or is the warfarin for your mitral valve? What rhythm are you in?
Ask what you target INR will be.
At 59 I would avoid all NSAIDS unless you have very good reason to use them.
Whatever you are doing wear a helmet. intracranial bleeding from trauma is very bad when anticoagulated. Bleeding form other sites can be bad but is more likely to be recoverable. If there is any way to avoid warfarin I would do so. If not then it is a matter of balancing the risk of sports against that of increased bleeding. this is of course very difficult to quantify.
In reply to Todgerman: Even if you have a pig valve fitted there's no guarantee you will manage to come off warfarin but at least you have a chance. As someone mentioned, any accident when you are on anti-coagulants is far more serious. Best to speak to your specialist and tell him your worries, they are in the best position to give you the most appropriate advice for yourself. Hope it all goes well for you.
In reply to Todgerman:
I'd be interested to know what your surgeon thinks and how easy it would be to get an On-X valve on the NHS (rather than the standard St Jude valve).
I'd be interested to know what your surgeon thinks and how easy it would be to get an On-X valve on the NHS (rather than the standard St Jude valve).
In reply to Todgerman:
I really think complex personal medical problems are better not aired on an open forum with no check on the expertise behind the replies.
You should have a surgeon to do the surgery, an anaethetist to put you to sleep and wake you up after the operation and look after you immediately post operatively. You have a GP for long term care. A pharmacist to advise on medication. Expert nurses in theatre and on ICU and the wards post operatively, Physiotherapists for post oeprative care. All these people should work as a team with complimentary skills.
If any of them need advice from the mountain medicine point of view they could involve an appropriate holder of the UIAA/IKAR/ISMM University of Leicester Diploma of Mountain Medcine. The subject of warfarin and mountain acitivities in the hills are frequently discussed by the diplomats. A list of holders can be found on www.medex.org.uk
David Hillebrandt
I really think complex personal medical problems are better not aired on an open forum with no check on the expertise behind the replies.
You should have a surgeon to do the surgery, an anaethetist to put you to sleep and wake you up after the operation and look after you immediately post operatively. You have a GP for long term care. A pharmacist to advise on medication. Expert nurses in theatre and on ICU and the wards post operatively, Physiotherapists for post oeprative care. All these people should work as a team with complimentary skills.
If any of them need advice from the mountain medicine point of view they could involve an appropriate holder of the UIAA/IKAR/ISMM University of Leicester Diploma of Mountain Medcine. The subject of warfarin and mountain acitivities in the hills are frequently discussed by the diplomats. A list of holders can be found on www.medex.org.uk
David Hillebrandt
be really careful with gel - it still enters your system and acts systematically (ie gel applied on your knee could still affect the control of acid production in your stomach).
the best natural inflammatory is ICE!
get some of those blue gel icepacks you keep in the freezer - for your knees - if icing them directly makes them a bit too stiff - try icing on the muscle just above - you'll be cooling the blood going in to them.
the best natural inflammatory is ICE!
get some of those blue gel icepacks you keep in the freezer - for your knees - if icing them directly makes them a bit too stiff - try icing on the muscle just above - you'll be cooling the blood going in to them.
In reply to David Hillebrandt:
I really think complex personal climbing lifestyle issues are better not aired SOLELY to medical professionals who may not understand the strong need for medical treatment and it's effects to fit in with someone's life and desires...
I really think complex personal climbing lifestyle issues are better not aired SOLELY to medical professionals who may not understand the strong need for medical treatment and it's effects to fit in with someone's life and desires...
1
In reply to Todgerman:
Just a few comments in reply to what other folks have said. I am a doctor, for what it's worth, but bear in mind I am not *your* doctor, and at the end of the day it's you who has to make the decisions on whether to accept or decline the possible courses of action offered by your own doctors and other professionals advising you.
Firstly, absolutely do discuss frankly your concerns with your surgeon. Have realistic expectations, however: it's extremely unlikely that you'll get this On-X valve, which as far as I can see has no license for use in Europe, and of which the only benefit you're interested in (lesser degree of anticoagulation) is completely unproven as yet. The important thing is to let your surgeon know that you are very keen to keep active, and are interested in all the alternatives, not just "the usual option".
Having said all that I reckon it's pretty likely you'll be stuck with a metallic aortic valve and lifelong warfarin. And if that's the case, it's because that is the best available option to keep you going.
Secondly, the problem with anti-inflammatories and warfarin is much more related to the multiplied extra risk of a bleed from your gut than a drug interaction, although non-steroidals (ibuprofen, diclofenac) do also tend to increase your INR if you're on warfarin. Gastrointestinal bleeding is a common and serious problem in people on either non-steroidals or warfarin, and the combination makes the risk much higher.
If you do end up on warfarin, it will be up to you and your GP (unless you see someone else about your joints?) to agree on what treatment is possible for your joints. He/she *may* decide to prescribe you either a lower-risk standard NSAID (ibuprofen is the safest) or a Cox-2 inhibitor (like celecoxib - *probably* safer than most NSAIDs in terms of GI bleeding), and he *may* decide to prescribe you a drug such as omeprazole or lansoprazole alongside it to reduce your risk, but you need to be aware that your risk of GI bleeding will still be higher. There's a good chance he/she will not even consider that an option, as the safety is only relative, and the jury is still very much out on it. The responsibility lies, pretty much, with the prescriber.
Having stuck my oar in fairly firmly, I do nevertheless largely agree with what David Hillebrandt has said; although I am happy to offer informal advice to allow you to have a think and prepare in advance of discussing options with your own healthcare professionals.
Finally, consider most strongly wearing a helmet, if you didn't before. If you are taking warfarin for a metallic aortic valve, your INR will be higher (i.e. blood "thinner") than most people who are on warfarin (often for heart arrhythmias like AF), and as warfarin is an unpredictable and tricky drug, your INR may well often be higher than you, or anyone else, had planned it to be. In that situation a relatively minor impact on your head could be very serious indeed. I've seen it happen plenty of times. Not happy news I'm afraid, but I'd rather you were aware.
Good luck,
Pete.
Just a few comments in reply to what other folks have said. I am a doctor, for what it's worth, but bear in mind I am not *your* doctor, and at the end of the day it's you who has to make the decisions on whether to accept or decline the possible courses of action offered by your own doctors and other professionals advising you.
Firstly, absolutely do discuss frankly your concerns with your surgeon. Have realistic expectations, however: it's extremely unlikely that you'll get this On-X valve, which as far as I can see has no license for use in Europe, and of which the only benefit you're interested in (lesser degree of anticoagulation) is completely unproven as yet. The important thing is to let your surgeon know that you are very keen to keep active, and are interested in all the alternatives, not just "the usual option".
Having said all that I reckon it's pretty likely you'll be stuck with a metallic aortic valve and lifelong warfarin. And if that's the case, it's because that is the best available option to keep you going.
Secondly, the problem with anti-inflammatories and warfarin is much more related to the multiplied extra risk of a bleed from your gut than a drug interaction, although non-steroidals (ibuprofen, diclofenac) do also tend to increase your INR if you're on warfarin. Gastrointestinal bleeding is a common and serious problem in people on either non-steroidals or warfarin, and the combination makes the risk much higher.
If you do end up on warfarin, it will be up to you and your GP (unless you see someone else about your joints?) to agree on what treatment is possible for your joints. He/she *may* decide to prescribe you either a lower-risk standard NSAID (ibuprofen is the safest) or a Cox-2 inhibitor (like celecoxib - *probably* safer than most NSAIDs in terms of GI bleeding), and he *may* decide to prescribe you a drug such as omeprazole or lansoprazole alongside it to reduce your risk, but you need to be aware that your risk of GI bleeding will still be higher. There's a good chance he/she will not even consider that an option, as the safety is only relative, and the jury is still very much out on it. The responsibility lies, pretty much, with the prescriber.
Having stuck my oar in fairly firmly, I do nevertheless largely agree with what David Hillebrandt has said; although I am happy to offer informal advice to allow you to have a think and prepare in advance of discussing options with your own healthcare professionals.
Finally, consider most strongly wearing a helmet, if you didn't before. If you are taking warfarin for a metallic aortic valve, your INR will be higher (i.e. blood "thinner") than most people who are on warfarin (often for heart arrhythmias like AF), and as warfarin is an unpredictable and tricky drug, your INR may well often be higher than you, or anyone else, had planned it to be. In that situation a relatively minor impact on your head could be very serious indeed. I've seen it happen plenty of times. Not happy news I'm afraid, but I'd rather you were aware.
Good luck,
Pete.
In reply to PeteH:
I wish my doctor explained things like you did instead of me having to find stuff on the web.
I wish my doctor explained things like you did instead of me having to find stuff on the web.
In reply to Todgerman: I have no advice, however would like you to know my thoughts are with you. I spent a year on Warfarin after tearing my bicep, I took all the precautions advised and was on the verge of selling my rack and giving up on climbing. However my girlfriend and close friends encouraged me to lower my grades and expectations... and forced me to ALWAYS wear a helmet!
Bizarrely I climbed some of my hardest grades that summer.
Good luck.
Bizarrely I climbed some of my hardest grades that summer.
Good luck.
In reply to Fiend:
I totally agree with yur comments. That is exactly why I suggested incorporating a holder of the UIAA/IKAR/ISMM Diploma of mountain Medcine into the team caring for this patient.
All the holders have to be active in the hills prior to starting the course. All are doctors or paramedics. Fifty percent of the course syllabus involves mountain skills in summer and winter in the UK and the Alps. All the practical sections are assessed by UIAGM guides. All candidates keep a logbook which is exactly the same as the logbooks used by the governing body's for UK instructor qualifications but include sections on mountain medcine experience. These logbooks areavailable for inspection if you wish.
All holders are active mountaineers and understand the psychology of our sport.
In short they do and will share the same lifestyle and desires. If not they would not have put all the work into obtaining the diploma.
David Hillebrandt
I totally agree with yur comments. That is exactly why I suggested incorporating a holder of the UIAA/IKAR/ISMM Diploma of mountain Medcine into the team caring for this patient.
All the holders have to be active in the hills prior to starting the course. All are doctors or paramedics. Fifty percent of the course syllabus involves mountain skills in summer and winter in the UK and the Alps. All the practical sections are assessed by UIAGM guides. All candidates keep a logbook which is exactly the same as the logbooks used by the governing body's for UK instructor qualifications but include sections on mountain medcine experience. These logbooks areavailable for inspection if you wish.
All holders are active mountaineers and understand the psychology of our sport.
In short they do and will share the same lifestyle and desires. If not they would not have put all the work into obtaining the diploma.
David Hillebrandt
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