Anticoagulants and 'slightly high risk' activities?

[angiek]

Hi everyone,

Nearly a year on from first diagnosis of Afib/ Aflutter (and much incompetence/disinterest/conflicting advice from my GP surgery later) I have at long last seen a cardiologist (his registrar) at my local hospital. He has advised that he will probably be referring me to an EP (they don't have them at Ipswich) and I will most likely be a suitable candidate for an ablation.

In the meantime after another 24 hr BP monitor (which didn't actually work very well most of the time) he has written to my GP asking for me to be started on Diltiazem for fairly mild hypertension and an anticoagulant.

When I called for an appointment to see my GP, who I have never seen before, he really only wanted a telephone consultation. I had so many questions for him which I would have been far happier asking face to face! (I really dislike this system) He managed to upset me as the first thing he said was that the registrar had indicated a Diltiazem dose which he considered too high for my situation, and whilst I am sure he knows what he is talking about it immediately made me question my Registrars knowledge...which is not a nice feeling.

The Registrar hadn't actually asked about my lifestyle, when discussing anticoagulants, Warfarin being the GP first drug of choice. I told the GP that I ride horses 4 or 5 times a week and help my daughter on her livery yard, so handling horses on a daily basis. I am not an adventurous rider (read.. wimp!) so don't intentionally do anything which may cause me to part company with my horse, but they can be unpredictable! Last year I didn't fall off at all, the year before I fell off twice! One of those falls did result in a huge haematoma on my thigh, the remains of which is still evident today. I am female, aged 59, fairly fit and well. My GP feels I should go back to the Cardiology dept. to discuss this risk further before starting on Warfarin, but is happy to start me on it if I make the decision.

Having no knowledge of Warfarin and how it may affect me if I bleed, I really don't know if there is an 'acceptable' risk level? I would be extremely unhappy for the rest of my life if I had to give up riding horses, but I would also be extremely unhappy or even dead if I had a stroke!

So...I know it will come down to personal choice but wonder if I could ask you all for your input/advice/experiences to help me make that decision.

Thank you,

Angie x

[BobD Volunteer]

HI Angie and welcome to our world. If you are going to see an EP with a view to ablation you will need to be on some kind of anticoagulant and I don't mean aspirin which is about as useful as a chocolate fire guard. Warfarin is obviously the first anticoagulant of choice for most GPs and has been in use for many many ears. I have been on it for ten now with no problems and whilst I am not a racing driver I am involved with motor sport at an engineering level in close proximity to sharp things that bite a lot of the time. OK so I bleed a little more easily but my wife who is NOT on warfarin has always bruised much more that I do. I think the only proviso I would make to to ensure that you wear adequate head protection. I'm not a medic of course but like many people here always refused to allow my condition to get in the way of my life.

There should be a way you can discuss this with your GP face to face and to be honest if you can't do that I would change GPs. CAREAF is a useful website which will help you to understand the choices and

you can down load a pack to wave at your doctor. We are all here to support but there is no substitute for face to face consultation.

[jennydog]

Confirming what Bob has written, my GP told me that if I banged my head then I was to seek medical help. Bruising is obvious but a bleed below the scull is not. A helmet will be essential for you but anticoagulation should not curtail your activities. We all are faced with risk all the time.

[Jason1971]

Hi Angie, I asked a similar question a while ago, as I too get knocked around a little with my pastimes. I have decided not to carry on with them whilst being anticoagulated, as bangs to the heads are common place for me and a helmet maybe somewhat of an advantage . I'd go with Jenny and Bob's advice and make sure you wear the correct safety equipment and I'm sure you'll be fine.

[jnh1]

Hi Angie,

From my experience I would think Warfarin is the least offensive of the anticoagulant available in your situation. However; if I were you I would be keeping the horse and changing your Doctors.

Hold on tight.

Jim

[Hidden]

I am a farmer and at higher risk of an accident than normal. My EP says I need to stay on Warfarin because they can give me an antidote which will work within 20 minutes if I should have an accident.

My wife was a keen and careful rider. Horses were her life. But she fell off due to her horse shying, all very minor, but it broke her back, this is last year. She has been very lucky not to end up paralysed or in a wheelchair. If I were you, I'd give up horses. At the hospital where she was, what keeps them in business is men on mountain bikes and women on horses, that's what they told me.

Koll

[dedeottie]

Oh dear my comment is not going to cheer you up!

Until 3 years ago I had 4 horses all of which I rode and competed at dressage. My husband also did the same. When I was diagnosed the consultant I saw told me he wouldn't prescribe an anticoagulant if I was to keep riding. He would prescribe aspirin instead but he told me that aspirin was a poor substitute for warfarin. I had already had 3 T.I.A.s so I chose the warfarin. I have had horses all my life and know that eventually I would fall off and probably hit my head. This is the big risk...internal bleeding not the kind of bleeding you can see like a deep cut on the arm. So we gave up our horses land and riding arena and house and moved closer to our family. This was the best thing we have ever done. We have had fun making new friends doing new activities and have enjoyed having time to catch up with old hobbies. We also have a new grandson and it is wonderful living so close. So, we all have to make up our own mind but sometimes life has a way of working out for the best. Good luck with your choices.x

[rosyG]

Having ridden a lot some years ago and having had many falls I would definitely not ride now I am anti coagulated. I think you probably know this yourself as it's not like riding a motor bike. If your chadsvasc2 score is such that you need to be anti coagulated then I think you have to put your stroke risk before the riding. I think you need to be careful when helping with the horses too - you'll know how hard a kick is- definitely fits the description of a contact sport !!= although slightly different meaning to 'contact!'

[Mike11]

I have been on Warfarin for 5 years and do get bad bruising which you learn to put up with. One hint I have for everyone is to always carry large Calcium Alginate dressings with you - these stop bleeding from even a large cut effectively so you don't lose much blood whilst someone comes to help you get to A&E if needed.

[Hidden]

I am a great believer in doing as much as you can, but I know horse riding can be quite rough on the body however good you are. You know yourself you will come off at some point, and you've already had a significant haematoma. That is something you really have to take into consideration - other people have mentioned head protection. I know I fell off a horse onto my head once myself, good job I landed on something soft!

Joking aside, I'd give it careful thought, sad though it may be to stop but if your Chadsvasc score suggests you need warfarin, it's a case of measuring the risk of stroke against your hobby. And if your doctor will only do phone consultations then I'd seriously try to find someone else, that's not good enough.

Lis

[MarkS]

Hi Angie,

That's similar to the predicament I had when I had to go on warfarin. I previously played hockey which I had to give up. I now cycle and I do fall off from time to time. The last time was when I hit a pothole under a puddle and crashed down on my right side. I had very bad bruising particularly on my hip. There was a big lump there. After two weeks of pain I went to the physio and she "ironed" it out and it was much better, the lump having disappeared. In a few days all pain was gone - brilliant. I was just left with a very colourful leg.

If you are to continue riding, it's essential you keep your INR in range on warfarin - i.e. not to let it get above 3. You could consider a Coaguchek monitor to help you do this. Also use back braces, big helmet, the works.

One question - would you just be on warfarin for the ablation rather than life?

If I were you I would go to London for an ablation and choose the EP carefully. It's only an hour from Ipswich.

Mark

[Vdl1]

I am on warfarin.....I ski and ride bikes....which I occasionally fall off....I never give warfarin a second thought....I carry on regardless ...if you have give up your lifestyle the af has won...keep going...

[angiek]

Thank you all so much for your replies....as predicted both 'sides' represented so still lots to think about and weigh up! I rang the Cardiologist secretary today to see what is happening with the EP referral/ablation etc. She promised me a call back early next week. Am I right in thinking I have to be anti-coagulated prior to ablation anyway, and that maybe after successful ablation it is then not necessary to continue on anticoagulants-or did I dream that up? I have an actual face to face appointment with my new GP next week too- hope I have made my mind up by then! Aaaargh I'm going crazy!