/ Climbing on Warfarin

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tri-nitro-toulumne on 13 Mar 2013
I'm just about to start taking warfarin (permanently). My INR will be between 2.0 and 3.0.

Does anyone here climb on warfarin? I would be interested to hear anyone's experience and advice.
Wiley Coyote - on 13 Mar 2013
In reply to tri-nitro-toulumne:
Yes. I've been on it for three or four years and targetting the same INR range. It doesn't make a scrap of difference. Cuts don't seem to bleed any worse than before nor am I any more prone to bruising. Take the pills and forget about it.You'll be fine
tri-nitro-toulumne on 13 Mar 2013
In reply to Wiley Coyote:

Cool - just what I wanted to hear.

Thanks :)
JasonV - on 13 Mar 2013
In reply to tri-nitro-toulumne: I've been on warfarin now for about 2 years (similar INR range to you). I've been back into climbing for about 1 year and was initially apprehensive about cuts and injuries (thinking about longer bleed times). Up until now it's been OK - even climbing on slate (which can give you nice little razor nicks) has been OK. I haven't been climbing as hard as before taking the warfarin and as a consequence haven't been knocking myself about as much. Still, I've managed to get some classics done and despite my initial worries it has been OK.
tri-nitro-toulumne on 13 Mar 2013
In reply to JasonV:

Thanks - all sounds good to me
JasonV - on 13 Mar 2013
In reply to Wiley Coyote: Yep I too was worried about bruising and as you say it doesn't make a jot of difference being on the warfarin.
jon on 13 Mar 2013
In reply to tri-nitro-toulumne:

I had the same apprehensions but managed a whole month of scraping my way up Californian cracks with no problems. As the others have said cuts don't seem to bleed any worse than before. However, they don't heal up quite as quickly as before - I've had jamming scabs for two weeks or more whereas they'd have normally gone in a week. I've got another month and a half and then I'm off it... woo hoo.
tri-nitro-toulumne on 13 Mar 2013
In reply to jon:

Interesting - I must admit I thought jamming might get a bit "messy". I can live with scabs taking longer to heal :)

Thanks.
Hannes on 13 Mar 2013
In reply to tri-nitro-toulumne: Just make sure you wear a medicalert bracelet or similar in case you were to fall off and require mountain rescue
jon on 13 Mar 2013
In reply to Hannes:
> (In reply to tri-nitro-toulumne) Just make sure you wear a medicalert bracelet or similar in case you were to fall off and require mountain rescue

And carry vitamin K: http://www.ashp.org/s_ashp/docs/files/member/SPPM_Warfarin_Reversal_Vitamin_K.pdf
Fiend - on 13 Mar 2013
In reply to tri-nitro-toulumne:
Yes. I've been on it for three or four years and targetting the same INR range. It DOES make a little bit of difference. Cuts DO bleed longer before clotting (naturally) than before and I AM more prone to bruising (naturally) particularly on my butt from sitting down belaying. But these are minor issues that cause no further harm or impedence. Take the pills and forget about it. You'll be fine
tri-nitro-toulumne on 14 Mar 2013
In reply to Fiend:

Ok - thanks for the info Fiend
redsonja - on 14 Mar 2013
In reply to tri-nitro-toulumne: been taking it almost 6 years. it makes little difference. i bruise easier, but all the doom and gloom prognosis my doctor gave me, is not true. carry on with your life as before and make your own decisions as to how you feel. i have also been to 18,000ft and didnt acclimatize as well as before. has anyone been to high altitude whilst on warfarin and did it make a difference?
jon on 14 Mar 2013
In reply to heidi123:
> i have also been to 18,000ft and didnt acclimatize as well as before. has anyone been to high altitude whilst on warfarin and did it make a difference?

Yes, but not that high - only 4200m. I felt like I was wading in treacle. However, I'm certain that this was not the warfarin, but the beta blockers I was on at the time. I don't think the warfarin contributed to it - but of course I have no way of proving it! As far as actual acclimatisation, I didn't feel there was a big difference - ie no headaches etc, just the tiredness.
redsonja - on 14 Mar 2013
In reply to jon: yes thats what i felt. i quickly recovered but was SOOO slow compared with how i had been before warfarin. when your body is acclimatizing your bolld naturally gets thicker and warfarin keeps it thin, so im not sure exactly how this affected me. i tried to ask my doctor but he just looked blank
oddtoast on 14 Mar 2013
In reply to tri-nitro-toulumne:
My other half finds he feels the cold more - don't know if common but maybe something to watch out for?
Fiend - on 14 Mar 2013
In reply to oddtoast:

That is a good point, I get cold hands more often than before - although this could be something to do with moving to Glasgow, having DVTs yadda yadda YMMV etc. Still bloody sweaty whenever I try to do any sloper problems though.

BTW, an ascent of this should be obligatory: http://www.ukclimbing.com/logbook/c.php?i=3415 , really good route, watch your rope drag though.
Crank - on 14 Mar 2013
In reply to tri-nitro-toulumne:
> Does anyone here climb on warfarin?

Our local climbing hot-spot was infested with crag rats, then a mate started climbing there with warfarin mixed in his chalk bag, and that cured the problem.
wilkesley - on 14 Mar 2013
In reply to Crank:

I have been on it for about 3 years now and as others have said no worries about cuts, etc. However, a GP friend of mine has warned me to be careful of head injuries, as apparently you are much more susceptible to internal bleeding from even relatively minor injuries.
jon on 14 Mar 2013
In reply to wilkesley:

This is what the vitamin K is for - to reverse the effects of the warfarin. I posted this yesterday: http://www.ashp.org/s_ashp/docs/files/member/SPPM_Warfarin_Reversal_Vitamin_K.pdf

I think as climbers we might well find ourselves in a situation where having taken a violent fall we haven't got instant access to medical help. I was very aware of that last September in a couple of places where it might have been a day before getting help.
ads.ukclimbing.com
damowilk on 14 Mar 2013
In reply to wilkesley:
Yes, it is head injuries that will be the major concern regards climbing on warfarin. It is probably reasonable to advise any partners you climb with on more isolated trips. Reversing with vitamin k will make no difference after a head injury, by the time you could consider it the damage would be done.
I'm not aware of any reason than warfarin would interfere with acclimatisation, this is probably more to do with the underlying condition and other meds like B Blockers.
jon on 14 Mar 2013
In reply to damowilk:

Do you not think it would be useful for other internal bleeding?
Wiley Coyote - on 14 Mar 2013
In reply to jon:

This is the first I've heard of the head injuries problem. In what format would carry the vitamin k?
jon on 14 Mar 2013
In reply to Wiley Coyote:

Well, maybe it's a French thing? I understood from my cardio that Vit K is prescribed automatically as a precaution when Coumadine is prescribed. Googling it tells me (in English) that it's for high INRs so maybe it's a case of the French being over cautious? I have two glass vials of the stuff which is supposed to be taken orally.
Wiley Coyote - on 14 Mar 2013
In reply to jon:
Thanks. I'll ask about it when I go for my next INR test
KA_R36 on 14 Mar 2013
In reply to Wiley Coyote:
Vitamin K is for high inrs only in the uk and also not oral (unless you are a baby). Your GPs wouldn't know anything about carrying it as we would never use it in this way.

All patients on warfarin should have been warned re head injury risk.
PeteH - on 14 Mar 2013
In reply to wilkesley:
> However, a GP friend of mine has warned me to be careful of head injuries, as apparently you are much more susceptible to internal bleeding from even relatively minor injuries.

I would definitely advise that if you're on warfarin, you consider wearing a helmet very seriously indeed if you don't already wear one... Being on warfarin is not likely to cause you problems with minor knocks, but the sort of bump on the head that would otherwise give you a bit of a concussion for a couple of weeks could be life-threatening, particularly if your INR is a bit on the high side.

This coming from someone who has treated lots of people with life-threatening intracranial bleeds who have been on warfarin - all the same this advice is based on anecdote and I'm quite happy to be outdone by someone else who has relative risks and suchlike to hand...

Pete.

PeteH - on 14 Mar 2013
Re: vitamin K, if you're only carrying an oral form (most likely) I think it would be very unlikely to be of help... Any impact significant enough to cause a serious bleed would probably impair your ability to take or absorb the vit K, and even if you managed to take it it takes hours to work, which is rather too long for what we're talking about here.

Pete.
Wiley Coyote - on 14 Mar 2013
In reply to KA_R36:
Thanks for the info. I wonder if someone did tell me to avoid head injuries and I just thought 'I've been doing my best to avoid them all my life anyway' and filed under Stating the Bleedin' Obvious without appreciating the extra importance.
I have now taken it in anyway.
Thanks again
Wiley Coyote - on 14 Mar 2013
In reply to PeteH:
> (In reply to wilkesley)
> [...]
>
> I would definitely advise that if you're on warfarin, you consider wearing a helmet very seriously indeed if you don't already wear one...

Funnily enough, although I hate helmets and have never worn one on summer rock, after reading this thread I've been Googling them.
krikoman - on 15 Mar 2013
In reply to tri-nitro-toulumne: Climbing on Warfarin - Walking On Sunshine, but which is best?
redsonja - on 15 Mar 2013
In reply to PeteH: i have been very fussy about wearing a helmet since i have been on warfarin even on scrambles and waking in to a climb. i feel a bit daft sometimes but never mind
redsonja - on 15 Mar 2013
In reply to damowilk: i dont take any other meds apart from warfarin, but maybe my slowness is advancing age!! interestingly, whenever i have been to altitude, even 6-9,000 ft, my INR is always lower the next time i get it checked. i suppose my blood is still thickening to cope with altitude? our bodies are amazing arent they?
jon on 15 Mar 2013
In reply to PeteH and KA R36:

What do you know about Xarelto?
mattbell - on 15 Mar 2013
In reply to tri-nitro-toulumne: Yes you can climb on warfarin. I wouldn't even be to worried about cuts etc, they will stop bleeding eventually. What you need to be more concerned about is major trauma and head injuries, which obviously we all try to avoid. If you have a head injury you're more predisposed to a bleed which will have a lot greater potential to be catastrophic. If you did have a bleed vitamin K is of no use at all it takes a couple of days to kick in. For this reason your climbing partner should be aware of what you're taking and worse case scenario be able to tell mountain rescue / paramedic what you're taking if something goes wrong!
Mark F - on 15 Mar 2013
In reply to tri-nitro-toulumne:

I was on Warfarin for 3 months last year following a dvt, and although I continued climbing during the treatment I was quite nervous about the possible consequences of a fall so it held me back psychologically quite a bit. I was also quite concerned about the risk of altitude as I had a couple of alps trips planned during the treatment (specifically I was worried about the risk of having another dvt); my concern wasn't helped by the fact that there is very little reliable information available and doctors have little or no experience in this area. In the end I decided on a safety-first policy of staying below 3000m, which I did without any problems at all. I have since spoken to a vascular consultant who told me that in his opinion climbing to 4000m, even 6000m, shouldn't be a problem, it is the journey to the climb that would worry him. So, he has advised me to wear compression stockings and have regular breaks during long journeys, and if I ever take a long haul flight to ask my GP for a couple of syringes of Heparin.
Becky E - on 16 Mar 2013
In reply to jon:
> (In reply to PeteH and KA R36)
>
> What do you know about Xarelto?

I am a pharmacist, and I specialise in anticoagulation, treatment of DVTs, etc.

Rivaroxaban (Xarelto) doesn't need the blood tests that warfarin does and it's a fixed dose. BUT there isn't a reversal agent yet. If you're a climber and you need anticoagulating, I'd stick with warfarin. At least if you bang your head or have some other injury, they can give you vitamin K (plus prothrombin complex if it's critical).

As PeteH said above, oral vitamin K won't work fast enough if your injuries are critical. We don't give people any "standby" supplies of vitamin K: just tell them to make sure that healthcare staff know they're on warfarin. That's why you get a credit-card sized card to put in your wallet. If you're on warfarin long term then a Medic-alert is a sensible idea.

Becky
jon on 16 Mar 2013
In reply to Becky E:

Thanks Becky. I live in France so I think there are quite a few differences in their approach to that of the UK - for instance the vit K thing was a matter of course - whether it works or not is another matter! I was on warfarin and BBs (and then Flecaine) to temporarily control arrhythmia. I've just had an ablation and my anticoagulant has been changed to Xarelto 20mg for a couple of months. Hopefully I'll be able to stop taking all medication soon. My GP, my cardio and the surgeon all know my background and seem reasonably happy that I'm on the stuff. They didn't really tell me much about it, however the guy at our local pharmacie told me exactly what you've just told me, hence my question. He also said to look out for unexplained bruising, nose bleeds and bleeding gums. Thanks again.
Becky E - on 16 Mar 2013
In reply to jon:
Hi Jon
Because they're all anticoagulants and all ultimately doing the same stuff to your blood (slowing down the clotting process), the general side effects will be the same. Hope the ablation has been successful.

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