Who here takes blood thinners?

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I’ve been taking Xarelto for about 8 months now, since being diagnosed with CTEPH. Taking it, and some other drugs has helped me tremendously in keeping me feeling good, and able to ride my bike. I ride mostly MTB, and my prescribing doctor warns me that I should stay away from high risk activities such as this, fearing a crash, and subsequent bleeding. The biggest worry he says is hitting my head badly, and suffering internal bleeding. I ride hard, and am an aggressive downhiller, but not into big jumps and downhill park stuff. I rarely crash, and in about 30 years of riding, I’ve never had more than minor scrapes.Of course I could have a big crash, but honestly, I feel like it’s just as likely that I’ll slip on an icy sidewalk, while not wearing a helmet.

Anyway, I just got a talking to from a doctor again last week about risky activities, and while I don’t see myself quitting the bike, I just wanted to hear what others here have to say about it. I’m sure there must be others here, living “dangerously”. Thanks in advance.

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Been on Coumadin / warfarin for 10 years now…DVT / PE back in the fall of 2019.

I have basically stopped mass bike racing as a result. No need to go through turns @ 30mph, elbow-to-elbow with guys trying to prove something.

I switched to triathlons for my competitive jones for a number of years, but the last couple of years I am just back to cycling. I still do group rides and have occasionally toed the line (after promising Mrs. P13 that I will not contest the final sprint).

I don’t have an opportunity to MTB often since I live in the Chicago area, but when I do have the rare chance to do it (like when I travel to Bentonville, AR), I ride relatively cautiously on descents.

As your doc noted, the biggest issue is falling, taking a blow to the head and having a cranial bleed.

That said, you have to live your life…I refuse to give up riding completely. My wife and I have discussed the risks numerous times and we are both comfortable with my choices.

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I just stopped taking Eliquis a couple weeks ago. Doctors orders were to take it for three months post surgery and that time has lapsed.
I’m a terrible patient. I calculated the half-life of Eliquis figured I’d be in the clear if I stopped taking it ~60 hrs. before a race. I only pulled that stunt for two races and took it as directed all of the rest of the time.
My doctor did advise me to lay off the high risk stuff as well as stay near major cities since Eliquis requires an antidote. Other than those two races I took the mtb pretty easy and did not ride alone for the duration of my time on Eliquis.

In my case the blood thinner was only precautionary due to a history of a-fib. A little header could become a MAJOR issue on that stuff. Be careful!

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I had two PE’s, one in 2015 and another in 2016. Been on Xarelto for almost 5 years save 6 months between my two PE’s. I’ll be on a blood thinner for life. I don’t really have a lot of the side effects people talk about. I had one massive bloody nose when I first got on it, but otherwise, no more than normal bruising, cuts are bloody at first but clot up pretty quickly, and never had any other issues. I mtn, road, and tri, and regularly race. I’ve been in a handful of wrecks on the mtn, one road, and never had issues beyond the road rash. I came down on my head pretty hard once at about 25mph, and no issues other than broken helmet. I was afraid for awhile and stayed away from road races, then just said screw it, you have to live your life. Be smart about it, but after have a few dust ups, I don’t believe I’m at too much more risk. Xarelto seems to be good about not just leaving you gushing blood, at least for me, so I don’t worry about bleeding out like I used to. It’s definitely not like warfarin or Coumadin in my observations with my father-in-law’s experience.

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Thank you for saying exactly what I wanted to hear! Yeah, in the time I’ve been taking it, I’ve had some small wounds which stopped bleeding in a fairly normal manner. I’ve hit my head a few times, never hard though, without any issues. The only times that I’ve felt like something has bled for a surprisingly long time is with really small stuff, like when I have a scab from a pimple or a mosquito bite that gets knocked off. When I first started taking it, I was afraid I’d sneeze, blow an o-ring somewhere, and bleed out! Oh well. It looks as though I’ll be on it for life as well, unless technology changes. I take 20 mg a day, but I’ve read that there is evidence that weaning back to 10 mg is sufficient for most people. I’ll fight that battle later, when I’ve finished with my numerous rounds of Balloon Pulmonary Angioplasty.

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Have been on warfarin for a few years now after unprovoked PE. I make sure I wear my id bracelet each time I go out and my usual cycle buddies know the story also should I knock myself out or, God forbid, be found in a ditch. One has to get on with life!

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I have been taking Xarelto since 2014. I wear an ID bracelet when I ride to let people know what I take should an accident occur.

I compete almost exclusively in time trials. Mass start races worry me for a variety of reasons. I will also ride in more casual “races” like centuries and gran fondos with my daughter. Riders seem to be spread out enough at those events to minimize my concerns regarding potential accidents.

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I had a massive PE in 2016 and was placed on Xarelto. I was told to be on 20 mg from the beginning. Last year after speaking with my hematologist about bike racing he moved me down to 10 mg. He said that I’m fine taking it with dinner, and by the next day racing if I did crash nothing that serious would happen on the blood front. I worry a lot less about bleeding out issues but it still pops into my head on fast corners and descents.

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*My background is Emergency Physician and worked in level 1 trauma centers for the last 15 years. In general you shouldn’t be too worried about intracranial bleeds on thinners. Yes your risk is increased, but not to the extent advertised. Reversal agents are available as needed (FFP, PCC’s, etc) and utilized, but I can say it is much more rare than people think. *

*I personally would only be cautious if I was far away from help (i.e. bike packing trip), 3+ hours from hospitals, etc. A lot of the literature is based on falls in the elderly (fragile bridging veins at baseline), and no great studies on athletes etc. A more recent abstract is here, although I don’t have the full article. *
Risk of falls and major bleeds in patients on oral anticoagulation therapy - PubMed
RESULTSAmong the 515 enrolled patients, 35 patients had a first major bleed during follow-up (incidence rate: 7.5 per 100 patient-years). Overall, 308 patients (59.8%) were at high risk of falls, and these patients had a nonsignificantly higher crude incidence rate of major bleeding than patients at low risk of falls (8.0 vs 6.8 per 100 patient-years, P=.64). In multivariate analysis, a high falls risk was not statistically significantly associated with the risk of a major bleed (hazard ratio 1.09; 95% confidence interval, 0.54-2.21). Overall, only 3 major bleeds occurred directly after a fall (incidence rate: 0.6 per 100 patient-years).

CONCLUSIONS in this prospective cohort, patients on oral anticoagulants at high risk of falls did not have a significantly increased risk of major bleeds. These findings suggest that being at risk of falls is not a valid reason to avoid oral anticoagulants in medical patients.

This is the lower risk… other studies:
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Direct Oral Anticoagulant Treatment and Mild Traumatic Brain Injury: Risk of Early and Delayed Bleeding and the Severity of Injuries Compared with Vitamin K Antagonists - PubMed
#### METHODS:

All MTBI patients taking oral anticoagulants in our emergency department between June 2017 and August 2018 were included. All patients on oral anticoagulants underwent immediate cerebral computed tomography (CT) and a second CT scan after 24 h of clinical observation.

#### RESULTS:

There were 451 patients enrolled: 268 were on VKAs and 183 on DOACs. Of the DOAC-treated patients, 7.7% (14/183) presented overall intracranial bleeding, compared with 14.9% (40/268) of VKA-treated patients (p = 0.026)

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AHEAD Study: an observational study of the management of anticoagulated patients who suffer head injury - PubMed
MAIN OUTCOME MEASURESPrimary outcome measure was rate of adverse outcome defined as death or neurosurgery following initial injury, clinically significant CT scan finding or reattendance with related complication within 10 weeks of initial hospital attendance. Secondary objectives included identifying risk factors for adverseoutcome using univariable and multivariable analyses.

RESULTSClinical data available for 3534/3566 patients (99.1%), median age 79 years; mean initial international normalised ratio (INR) 2.67 (SD 1.34); 81.2% Glasgow Coma Scale (GCS) 15: 59.8% received a CT scan with significant head injury-related finding in 5.4% (n=208); 0.5% underwent neurosurgery; 1.2% patients suffered a head injury-related death. Overall adverse outcome rate was 5.9% (95% CI 5.2% to 6.7%). Patients with GCS=15 and no associated symptoms had lowest risk of adverse outcome (risk 2.7%; 95% CI 2.1 to 3.6).
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Incidence of intracranial bleeding in anticoagulated patients with minor head injury: a systematic review and meta-analysis of prospective studies - PubMed
A total of five studies (including 4080 anticoagulated patients with a GCS of 15) were included in the analysis. The majority of patients took vitamin K antagonists (98·3%). There was significant heterogeneity between studies with regards to mechanism of injury and methods. The random effects pooled incidence of ICH was 8·9% (95% confidence interval 5·0-13·8%). In conclusion, around 9% of patients on vitamin K antagonists with a minor head injury develop ICH. There is little data on the risk of traumatic intracranial bleeding in patients who have a GSC 15 post-head injury and are prescribed a direct oral anticoagulant.
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Once again, not a similar population to us, overall risk of 5-10% after minor head trauma on Coumadin, and most likely less so on DOAC (direct inhibitors).Preformatted text

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This is very helpful! Thank you for contributing!

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Thanks!