Internal Bleeding Concerns

Shop deals on ebay
shop deals on amazon
Advertise with us
Valve Replacement Forums

Help Support Valve Replacement Forums:

This site may earn a commission from merchant affiliate links, including eBay, Amazon, and others.
scott.eitman

scott.eitman

VR.org Supporter
Supporting Member
Joined
Jun 7, 2010
Messages
457
Location
Beachwood (Cleveland), OH
My re-replacemnt surgery is in 11 days. I am still debating whether I want to be on Coumadin. My concern is that I ride my bicycle about 3,000 miles a year (not this one). The problem is that I go down at least once every year or two. Last year I just slid out. The year before, I went over my handlebars. In 1993, I went head on with a car. I can go on and on, but Mom I can't stop riding.

What are the internal bleeding concerns that I should have on Coumadin?

I assume that after each downed experience I will need to go the the ER. Will I and what will I experience there?

Scott
 
Scott if you injure yourself bad enough to go to the ER, it wouldn't matter if you were on Coumadin or not. Honestly, your not as fragile as an eggshell when anticoagulated. Take a look at what some people are doing in the Active Lifestyles forum. Biking, Skiing, Tae Kwon Do, Karate, the list goes on and on. People have to get over this irrational fear that they'll bleed to death if anticoagulated. It's simply not true. Lord knows the medical profession makes it sound like that, but in reality, if your compliant, stay within your range, your not going to have any problems. You'd have to have a major major accident before having to go to the ER.

As far as what to expect should you have to go: Expect everyone to have a different opinion about what should be done. Doctors are not on the same page and most have no idea how to manage an anticoagulated patient. Organized chaos is what I call it. Things are beginning to change with the new doctors coming out of school, but most of the older ones were taught old, outdated concepts and simply taught it to the future doctors. One thing, if your INR is way over range, say 8+, they will give you fresh frozen plasma or Vit K to rapidly reverse the effects of warfarin. You'd have to be extremely noncompliant to run into that predicament.

Give you a little visual here. A normal persons blood begins to clot in about 10 seconds. Anticoagulated, it's 19 to 34 seconds. It's not that you'll bleed out, it's that it takes a little longer to stop the bleeding. It will stop unless you lop off your head, arm, leg, or other member, in which case you'll be going to the ER or to the morgue.
 
The Bid Deal to be concerned about is a Brain Bleed.

Do everything you can to protect your head.

As Ross said, scrapes and bruises will heal, they just take longer in an anticoagulated patient.

You might also want to ask your Doctors (PCP, Cardio, Surgeon) but be aware of their background (i.e. Old School or New School). FYI, the INR testing protocol for monitoring INR and adjusting doses wasn't created until the early 1990's. Before that, it was based on measured clotting times and it turns out there was considerable variation in the reagents used for testing which led to wide variations in control and outcomes. That's where all the Horror Stories about being on Coumadin came from.

'AL Capshaw'
 
Like others have said, you need to wear a good helmet, for head protection, but you probably do that now. As you would expect, I have had a number of head bumps for various reasons over the years. I have had only two instances that required a visit to the ER. Once when I was hit in the back of my head by a ceiling fan blade :confused2:that required a few stitches and most recently in Dec 2009. I fell off a ladder in my garage and hit hard on my elbow and my head bounced off the floor. I got several stitches in the elbow but had no damage to the head(although my wife might say differently:angel:).
 
scott.eitman said:
Thanks. Why the concern about the head as apposed the the rest of the body organs? Is it just because it is the head? Luckliy I have protected it pretty well over the years. My wife might say otherwise...
Click to expand...

The head is an issue for anyone. Not just those on Coumadin, but some people say or think that there is an increased risk of breaking vessels in the head. Dick tested that theory out with the ceiling fan and it proved to be a nonevent. I got nailed by a ceiling fan too, though not as badly as Dick did. I'm forever banging my head on something. So far, so good. I wouldn't recommend riding your bike straight into a phone pole without head protection however.
 
I'm a triathlete and do about 1,200 miles a year on my bike. I've gone down a couple of times at over 20 mph, once hitting my head hard enough on the pavement to crack and flatten the side of my helmet.
There is probably some marginal increase in inter-cranial bleeding risk by riding, but it's not enough to get me to give up my bike for a rocking chair yet. It will probably be my knees and back that stop me from doing this stuff, not Coumadin.
Good luck - see you on the road.
Mark
 
MarkU said:
It will probably be my knees and back that stop me from doing this stuff, not Coumadin.
Mark
Click to expand...

Mark makes a very good point. Over the years my interests and activities have changed a lot....but I am 99% sure that the changes have had little to do with Warfarin(coumadin).....and like Mark, I am a ways, but not a long ways, from the rocking chair:frown2:.
 
scott.eitman said:
Thanks. Why the concern about the head as apposed the the rest of the body organs? Is it just because it is the head? Luckliy I have protected it pretty well over the years.
Click to expand...

Scott,

The reason we stress head injuries more than others is the head is an enclosed space, and if you have an intracranial bleed there's no place for the blood to go, plus in an anticoagulated patient it takes longer for the bleeding to stop, so more damage gets done. Internal bleeding of any kind isn't good, but in other parts of the body, there are ways to get the bleeding to stop. (Not pleasant, but possible)
 
Yes, when I had a brain bleed from a high INR that was not from noncompliance, but bacterial endocarditis, I was not given coumadin for a few days and was given FFP's and Vit K. I'm not a blathering idiot, yet, from that experience, nor did I have a stroke. I was then given heparin and then was back on coumadin within the week. Not knowing much about bleeds, I wasn't too concerned, really, and just believed my docs when they said the bleeding in the brain was more risky than a stroke from no coumadin for a few days. It all worked out.
 
Crashing & Bleeding

Crashing & Bleeding

If it helps reassure you that you've made a good decision...

Rehab got me back into cycling back in 2007. I started mtn biking at about six weeks post op. I did one of those end over end tumbles at several months post op. Basically, ended-up no worse for wear after dealing with all of my fingers being dislocated on my left hand, bruises, and scrapes. I did get a decent, new road bike out of the deal as my wife wanted me to ride more frequently where there were more people.

Had a really bad crash again on the mtn bike in 2008. No major internal bleeds, but lots of big bruises and scrapes. Despite being banged-up pretty good, I still rode over ten miles back to the trailhead where my truck was parked and drove myself home. I also logged well over 3,000 miles on the road bike in 2008.

In June of 2009, someone did the hit & run thing on me while I was training for a major century ride event. The impact was hard enough to break ribs and give me a traumatic brain injury. My helmet undoubtedly saved me. Somewhere, I lost the entire month of July, but again, no major internal bleeds. I returned to riding my road bike bruised, and broken about four weeks after the accident. The accident did keep my road miles in the neighborhood of 1,800 miles in 2009.

I frequently do the minor crash thing on my mtn bike and typically ride away with bruises, cuts and scrapes. It's just part of the game and the people I ride with bruise, cut and scrape when they crash despite the fact that none of them take coumadin.

Please keep in mind that the injuries and the severity of the injuries we might get when we pursue activities like cycling vary. It may sound fatalistic, but I figure when it's my time to checkout, I'll checkout regardless of what I'm doing. Bruises, scrapes and broken bones heal.

Valve replacement surgery should be about getting a problem fixed so you can get on with your life. If you want to continue cycling after your surgery, why wouldn't you keep doing it?

Life's short... ride hard and pedal fast.

-Philip
 
Scott,

I'm glad you were able to make a decision. Now it's good luck to you on the 27th. I'd like to say I'll be thinking of you but I won't be thinking of anything as I'm having AVR myself that very day. I'm a newbie though. I hope to get the On-x myself and never need this surgery again. I'm planning to be a home tester too.

I'll race you to the recovery room.
 
For the both of you, New Guy and Scott, when you first start on this stuff, don't let things get to you. If your having problems, which virtually everyone does, just give us as much information as possible about you, your diet, excercise level, meds etc, and we'll help you get it sorted out. It's really not that big of a deal, but the medical profession makes it out to be far more complicated then it really is by overthinking it.
 
Another round of OHS buddies going through together! Scott & Doug, you guys make sure to hold hands now, lol, like Penny and Angel did. But seriously, best of luck to both of ya! We'll see ya soon over here where the party is. And I like it - a race to recovery!

As long as we're talking about bikes... What about motorcycles? I've just bought a small one to learn on, and if I like it, I could see myself getting a bigger one some day. So my question is - how much more at risk am I being on Warfarin on a motorcycle vs. a 'normal' person on a motorcycle? Knowing full-well that motorcycles are dangerous in general, anyone have thoughts about whether that danger is significantly more being on Warfarin?
 
Thank you Ross,

How long does it take to get things figured out? Andy, you're pretty new to Warfarin, have you had any issues staying in your INR range yet? I already know that if I'm having a difficult time I'll come here for insight.
 
You must log in or register to reply here.

Latest posts

Back
Top