UKC

Hello! Has anyone got any experience of climbing whilst taking anticoagulants? In particular, rivaroxaban? Any problems? Any advice welcome!

I'm on the rather more "blunt instrument" warfarin as rivaroxaban didn't work.  But to me it's basically summed up as...

1. Banging your head hard can be very, very bad as a minor bleed might not clot and thus you end up with a stroke.  Thus, you may choose to wear a helmet in more situations than you did previously, or if you solo or highball boulder perhaps rein that in a bit.  I didn't wear a cycle helmet before I went on it, now I do.  I don't wear one for indoor climbing but did for outdoor so it didn't really change much there.  The risks from other internal bleeding are also higher.

2. If you scrape your knee it might bleed a lot and look quite impressive.

2 isn't that significant, maybe carry a better first aid kit.  1 does affect the risk profile of climbing and scrambling (and similarly stuff like mountain biking).  If you're happy with that increased risk, go for it with whatever mitigations you see as fit.  Oh, and don't tell your doctor, they'll just panic.

There are a lot of people on "support" type websites that seem to think blood thinners changed their life, I didn't see any reason why they should, they just made me evaluate a couple of risks again.  Playing rugby would probably be ill advised due to the very high risk of head injuries, but that aside climb on.  The only exception to that may be that you may find getting insurance for international climbing more difficult or expensive.

Iv been taking Apixaban 5mg twice a day for two months and haven’t had it make any noticeable difference to me! Made a conscious decision not to change anything I do! Ride motorbike's and climb lots and have a nice time! Life is too short to worry!! Hope everything goes well for you!  

Very pragmatic advice.

I have been taking Warfarin since 2011. If you use Warfarin you will have your INR checked regularly. Provided your INR reading isn't much higher than your target you can expect to bruise more easily and minor bleeds will need you to apply pressure to stop the bleeding. Head injuries are potentially much more serious if you have internal bleeding.

A common misconception about blood thinners is that they actually thin the blood, i.e. would mean fewer red blood cells and thus affect athletic performance.  They don't, they just affect the rate at which it clots - effectively inducing mild haemophilia (which warfarin does effectively by inducing a Vitamin K deficiency, whereas the DOACs do a little less bluntly by directly affecting clotting factors).  Thus they don't affect athletic performance in any way.

In essence all they can do is make you bleed more if you're injured, and that's the basis of your personal risk assessment.

Main thing I've found is that razor nicks bleed for ages, so I've gone over to electric.  Which is nowhere near as good, but at least won't have me late for work while trying not to bleed everywhere.

I can also tell when my INR goes high (e.g. if I've had a pint or four, as the elimination mechanism of warfarin is directly affected by alcohol) when these things are worse than normal!  Indeed I recall a conversation with the nurse the first time saying something like "we don't like putting younger people on warfarin because they get drunk, fall over and bang their heads, which is about a worst case scenario".  You can drink, but just need to be a bit sensible.  DOACs aren't affected in the same way - alcohol is a slight anticoagulant in itself but it's negligible.

I've been on apixoban 2.5mg twice daily for about 3 years now, and it's made no difference to me.

The little cuts you pick up from the Grit maybe bleed a little more, but still clot fine.

Obviously not experienced a major bleed, and I appreciate that there may be an increased risk, but I'm not going to let it stop me doing stuff I want to do.

I think if I was planning a higher risk activity (which I'm not!), I'd probably tactically 'forget' to take my meds for a couple of days (please don't take my advice on this. Obviously I am not a medical professional!)

If you need major dental or surgery work doing, they do take you off it for that day, the risk of reclotting in such a short time is fairly low compared to the risks of major bleeding.

For warfarin, this is a nuisance, you have to transition to heparin injections.  For DOACs it's fairly easy, just don't take a tablet for a day or two.

Not sure if I'd do that just for a climb, though obviously you take your own decisions based on the acceptable risk to you.

Like others I'm on Apixiban 5mg twice daily, have been for 2-3 years - basically it takes longer for little cuts/nicks to stop bleeding, just means that if you do graze when climbing (especially on grit), you have to wait a bit longer before getting on the next one. Dabbing with chalk still works, just less effectively.

I've not done any serious, sustained jamming but if I was contemplating routes with gnarly jamming, I think I'd invest in some jamming gloves.

Had to come off them a couple of days before a minor surgical procedure (c.f. Sheil Yerbouti track 3), but I've no experience of any serious bleeding and hope I'll never find out.

I'm on Apixaban. How long is it before your blood is back to "normal" after you stop taking it?

Cheers,

E

I have had a beard almost all my adult life With Warfarin it's worth remembering that foods with a high potassium level e.g. sprouts will inhibit Warfarin. Quite how many sprouts you need to eat to have a serious effect I don't know.

I have had to stop warfarin and go onto the clexane a couple of times when I have had an operation. Our local haemo consultant will no longer prescribe clexane for some reason, so you have to badger the consultant who is doing your operation to prescribe it for you.

Probably better to buy cellox granules and a trauma dressing, so you can deal with a major bleed if necessary.

I believe it's 24hrs after the last dose, or close to that.  However if you are considering stopping it for a risky activity please do think carefully and seek proper advice!

Certainly 24hrs from the last dose is what is used for surgery.

While it can look impressive if you scrape your knee, internal bleeding is by far the higher risk, particularly in the brain if there's a head injury.  Conventional first aid approaches will stop external bleeding unless your INR is off the scale/you've overdosed on a DOAC, it just takes longer.

With warfarin you can reverse the effect with a massive dose of vitamin K, ideally intravenous but oral also works to an extent (and cheap Berocca usually contains it).  I can't recall if there's an antidote to rivaroxaban or apixaban, there didn't used to be but I do recall hearing one may have been in development and may now be available.

I think it depends on your dose.  I'm on quite a high dose (2x10, 5x9mg a week) so it makes no discernible difference what I eat.  A heavy night does, though, I've worked out (I have my own testing meter) that if I take 5mg instead of 9/10 the day after a heavy night instead of a full dose it evens it out reasonably.

The hospital prescribed it (not clexane, another LMWH in my case) when I needed it, didn't need to badger them, they just did it.  I hate the stuff to be honest, the injection itself isn't painful but about 10 seconds after you inject it it feels like someone's kicked you in the injection site, and you end up covered in bruises around the sites too, looking like some sort of addict.

Please don’t do this, unless the high risk activity you’ve got planned is ‘having a stroke’.

The half-life is about 8 hours, so within a day your clotting will be reasonably back to normal and within 48h completely normal (assuming it was ‘normal’ before)

Or an activity with a high risk of a head injury, which can lead to one due to the reduced clotting ability.  Such as doing a hard solo or highball problem you were planning.

They do take you off them for a day if you're having surgery.

Better not to though.

I am very surprised  at people willingness to reveal the exact medication and dosage that they have been prescribed. But if you must, can you please include the reasons why you are on this medication so it is possible to make a more informed decision about there usage.

I have read the information that is provided with some of these blood thinners and it did frighten me.

John

I am taking lifelong Warfarin. In about 2010 I had a swollen calf muscle. A visit to the GP who thought it was probably a DVT. Off to the hospital which confirmed it was a DVT above my knee. No known cause. I was taking Warfarin for a year and because it was my first DVT with no obvious cause that anyone could find I stopped taking Warfarin.

About a year later I had another DVT in the opposite leg, which was also above the knee. No apparent cause for this, so I am on lifelong Warfarin. 

Why?  I can't think of any way in which it could be misused.  It's not like you can go to Tesco and buy a bottle of milk, a packet of crisps and a pack of 10mg warfarin, other than maybe in the rat poison aisle.  And if you do want a (fairly weak) OTC blood thinner there's always aspirin.

Two DVTs and a PE (meaning lifelong anticoagulation) followed by a reclot on rivaroxaban (meaning a switch to warfarin).

Fundamentally if you make your blood clot less readily bad stuff can happen.  None of that is really strange.  It just means reassessing a few risks.

By the way I did manage to massively smack my head on a tree branch a few weeks back, and while I was a bit nervous immediately following it of the risk of Bad Stuff happening, it didn't and I got away with it.

On Apixiban due to AF (except having now captured some ECGs it's probably a different arrhythmia - waiting to find out whether that's better or worse). I was on the cusp of needing anticoagulation from the stroke risk score so the decision was left to me; decided better to get on it and then worry if any bleeding from climbing (i.e. gritstone rash) became too inconvenient.

Can't be treated for the AF with beta-blockers because I'm naturally bradycardic (36 is my lowest score, 40-42 is normal when lying down).

The need to stay on anticoagulants was rather confirmed by what we can only deduce was a TIA early in 2022 - but it was very short-lived and left absolutely no detectable evidence - which is good from one point of view but means that I can't ever have complete certainty about the diagnosis.

Curious as to why you're surprised at others willingness to disclose their meds ?

For most drugs, the dose is the usual licensed dose for a specific condition that needs it. The dose may vary by condition, so discussions about doses do indeed need info about reasons. But rivaroxaban for pulmonary embolism is 15mg twice a day for 3 weeks then 20mg once a day. 

Warfarin is a bit different. The dose required is the dose that makes the blood (for want of a better way of putting it) take twice as long to form a clot (usually). I know some people on 1mg/0.5mg alternate days to do so, and others on 25mg a day - it's not a reflection on the individuals other than perhaps what genes they inherited. 

For some people - e.g. with metal replacement heart valves - warfarin really has to be every day as significant risk of stroke. For others forgetting a dose here and there is probably not a major risk. So anyone asking advice has to be clear about why they are on it...

b

The medication will have been prescribed to help manage an underlying condition. I'd remain mindful of that too.