High risk sports and anti-coagulants

[Kent2007]

My cardiologist has recommended that I go onto anti-coagulants. At age 66, this was not a surprise. Although my AF episodes are mild and infrequent by many sufferers' standards, I'm sure he is right, but...! My reluctance to date is because I indulge myself in what many would regard as 'high risk' activities - rock/ice climbing and mountain biking. In essence, I have to balance the risk of a stroke against the risk of bleeding to death if I had a serious injury in a remote place (in over 45 years of this activity, I have never had a serious injury, but it could happen). Has anyone else out there faced the same dilemma? How did you resolve it? If you went for the anti-coags, how did it change what you did?

[Hidden]

Hi Kent 2007, I think, first of all that you shouldn't be putting the things you love on hold because you are prescribed an anticoagulant. Most people who are prescribed one have those feelings of dread and doubt initially but soon realise that life goes on pretty much the same as it did, afterwards. This applies particularly if you are prescribed one of the newer NOACs as opposed to warfarin which needs more monitoring (although there's an easier and quicker antidote to that, anyway). But good news is, severe bleeds with NOACs are relatively rare.If you were in a remote spot and had a significant bleed from an accident, wouldn't you be at risk anyway? Yes, you might potentially have an accident with or without an anticoagulant and both scenarios might require an air ambulance in a tight spot. In general there's no more bleeding from an anticoagulant; it just takes a little longer to stop. Not taking one might find you in a remote spot and having a stroke. People tend not to consider the devastating effects of those, and the hugely elevated risk of having one when you have Afib. if you had a stroke half way up a mountain you might anyway miss the 'golden hour' in which you can be treated with the best success. I'd at least give anticoagulation a bit of a chance. I think you'll feel very different after you become familiar with it. I did, for sure.

[Kent2007 in reply to Hidden]

Thanks for that - very encouraging and some good points. If you're a climber yourself, you'll know that there are alternative formats that involve less risk (although some of the satisfaction comes from taking on but managing the risks). So, all is not lost anway.

[Hidden in reply to Kent2007]

Kent 2007, I get scared at the top of a stepladder, so hats off to you, and keep doing what you love doing!

[BobD Volunteer]

Firstly it is important to understand that AF regardless of how often or how severe increases stroke risk by 5 times. Anticoagulation can reduce this risk by 70%.

Anticoagulants do not thin blood as is so often described (they merely slow down the clotting process) so bleeds would still need an injury. The main risk for you would be a bad bang on the head which could result in a brain bleed but that is a constant risk I would have thought in your chosen hobbies so no doubt you take precautions. Remember that any injury serious enough to need emergency treatment will do so regardless of anticoagulation or not. Minor cuts and such still respond to pressure and bandage ie normal first aid.

By now you will realise that I am in favour of you contnuing as you are even though such sports are anathema to me.

At more than ten years your senior for my part equally physical and dangerous "sports" include building race car engines, transmissions and in some cases complete cars using a variety of dangerous looking tools and machinery not to mention bits of flying metal when machining. Never had a serious problem in nearly 20 years on Warfarin though I did once fill a rubber glove with red stuff without even knowing I had hurt myself. lol 😁

If you really must do these insane things then don't let AF stop you.

[paulypurplepants]

I am 60 and mountain bike and recently went through a month of constant AF. Before that I'd had a couple of short episodes no longer than a day. Ive explained this on other threads, but will repeat what my Cardiologist said to me, as I think it clarifies a lot about Apixaban and why its prescribed: When you are in AFthe heart is not pumping the blood in/out of a small pocket in the heart correctly, so after a period of time , no idea how long....but longer than a day or two.....the blood can get stuck there and coagulate. Only when you come out of AF and the heart is pumping correctly can this blood be expelled from the pocket and into your system, thus creating the risk of a Stroke. So for me, it was prescribed when in constant AF, but not when I was flitting in and back out again. Since my Cardio Version on 27th Oct, Ive been in normal rhythm, so coming off them mid Dec.

[MarkS]

I used to play field hockey, very keenly but to a low standard! I had had AF for about 10-15 years when I had a TIA at the age of 58. I was put on warfarin and immediately stopped the hockey, which was quite devastating. There was too much risk of a bang on the head from the ball or a stick, which could produce a micro-bleed that would be much more difficult to control. However, I expanded the sports I took part in, including dingy racing, cycling and various other country pursuits. They have dangers but they are manageable. I found I enjoyed them just as much as the hockey. I also found I could walk down stairs on a Sunday/Monday morning without clutching the banister and lowering myself gingerly! I keep myself rigorously in the right INR range for warfarin, which is a good choice for adventurous activities as the antidote is widely held and acts in about 10 mins.

So, I think you need to look at the risks and judge for yourself. Perhaps consider mountain climbing rather than rock climbing? I still love climbing mountains, though I did have a close friend who was killed on Tryfan due to a navigation error. 😪

Mark

[secondtry]

At 68 I am a couple of years older than you...but patently in spirit a lot older. So don't read on unless you have an open mind on the subject.

To answer your question first if you are having regular episodes, say at least one a month, and some last over 12 hours, I would take ACs.

More importantly is your need to stop the episodes (AF begets more AF) as soon you won't be able to enjoy active hobbies. As you are no doubt aware the causes of AF are very individual and very possible each of us has multiple causes - this Forum regularly discusses them. One of yours may be your extreme sports (nb the AF is unlikely to happen on a rock face, more likely when fully relaxed later) and I would pause them for 12 months substituting something easy you have always wanted to try (e.g. I gave up skiing and took up walking basketball & love it). You will then give yourself a window with other lifestyle changes to correct the issues causing the AF.

Best wishes

[Jajarunner]

For an external bleed there are packs you can buy, the sort of thing the army uses, to stop it quickly. Obviously that doesn't help an internal bleed though, but just an idea.

[KMRobbo]

Have you considered an ablation to stop the Afib?

As regards A/C:

NOT MEDICALLY TRAINED , but I think I understand that the current thinking on AC was to use the Cha2ds-vasc score versus the Has-bled score for AC when having AFib to decide if AC is necessary.

Presumably your medic has followed this?

However FYI if you are not aware so you can consider: (knowledge is power )

mdcalc.com/cha2ds2-vasc-sco...

mdcalc.com/has-bled-score-m...

I am only 61 with no other known issues, so my Cha2ds is zero anyway

Post ablation not on AC ( EP advised me to stop it , I believe he was following NICE guidelines)

I myself do a bit of climbing/ scrambling ( not much last 2 years unfortunately), I ride motorcycles ( Inc occasional track day) and ride push bikes mostly road , and do not want to stop any of them .

Accidents wise for me the pushbike is the most dangerous in terms of number if incidents/ crashes / bangs.

When on AC I was most concerned myself with head bangs and consequent internal bleeds causing stroke rather than external bleeds or blood flow blockages owing to clots ( I watched a documentary once where a man - a retired NZ war hero I think- on A/C fell and banged his head and had internal bleed/ stroke which severely affected him, and he was lucky to survive at all. That also affected my thinking/ perception of A/C TBH).

I also had 2 issues with bleeding pre afib when my doctor followed some scheme where all over 50s with higher cholesterol were to take low dose aspirin daily to reduce heart attacks . I had massive bruising after 2 accidents, one a minor falling off my bike on black ice at 1 mph which would have normally been a 2 inch bruise on my hip, had a bruise from my foot to my stomach with a lot of swelling. So I took myself off the aspirin!

However I must say when I was on pradaxa AC, 25 days before/ 4 months after ablation I did not noticeably bruise more than normal, and the cuts I had did stop bleeding only slightly more delayed than normal . Not twice a long or anything dramatic.

The other thing to consider is the risk of A/C or not A/C versus the general risk of your hobby ( is it really much higher than currently).

Also consider the extra risk versus the general risk of life itself.

ie - it would be a pity to give up all your pleasures now just to get knocked down by a bus in 6 months time ! Lol.

Best wishes for your decision. It will probably be the right one!

[Wonkyheart]

I'm in a similar situation, even more so before last year as I managed an outdoor activity centre so it was my job and lifestyle.

Only you can decide.

Classic risk assessment looks at likelyhood and consequences. If you keep doing what you're doing now the likeyhood stays the same, if it's very small in what you do it doesn't it matter too much that the consequences may have risen slightly due to the AC. Then factor this into a risk-benefit analysis (eg effect on your mental health of giving up) and you'll have your answer. In the industry this is what we did to justify taking people into potentially dangerous situations. Everyone thinks we just get paid to go out and play... so very wrong!

[KMRobbo]

Sorry pasted Chad's link twice originally , now amended original post for has-bled

hsmdcalc.com/has-bled-score-m...

[AFCyclist]

The main risk is an internal bleed from a bang. Do the simple stuff. Wear a helmet...and other protection. Wear a wristband stating warfarin etc. Modify routes. Carry a mobile phone.Enjoy your sport.

[beach_bum]

Hey Kent, don't fret.I am in the same boat...66, highly active in mountain biking, gravel biking, and I use chainsaws and brush cutters a lot...I also ride motorcycles, so ya, there is above average risk there, but, I was reassured that Xeralto would not cause me to bleed to death lol. So, of course, I, being me, had to inadvertently test that theory. I have had a few incidents (some say accidents, that saw the red stuff...that is supposed to stay non the inside, leak out 😆

On one occasion I tore up my calf pretty bad on a granite Boulder, and it bled from multiple wounds. It was not a sight for the faint of heart 😏...anyhoo, no biggie, I had my first aid kit with me...loads of swabs, lots of pads and gauze, and off I went...cursing and peddling merrily on my way. I have had plenty of cuts and gashes as well, with no issues except for ruined clothes.

I can only vouch for me though.

Warfarin however is a different drug and has many more precautions, so always consult your doctor. 🙂

[BobDRedfish]

I've been on Apixiban for around 4 years now and am a martial arts instructor, this involves quit a lot of impact on occasions.

I was conerned initially about what would happen with bruising but there have been no issues that I've noticed, as in no more than previously The only adjustment I've made is to avoid repeated head impact but the reality is that we we should all do that, anticoagulated or not.

Having been over the handlebars of a moutain bike a few times I would suggest the risks are already there and the anticoagulation will make little difference.

I've had a few head injuries that have caused bleeding and I can't say I've noticed it being any different than before.

[msc667]

Not a doctor, but thoughts on anti-coagulation have changed somewhat based on articles over the last 15 years and talking to 2 differents EPs. Recent guidance is around if you are PAF, symptomatic, have a smart watch that you can randomly check for SR, and your CHADSVASC is lower, then it is more appropriate to use it as PiP. I know that is what I do based on EP at Cleveland Clinic.

[Cangelo629]

I am very active in NSR mostly and on Eliquis I have had two cardioversion I'm 62 life long gym user, runner, hiker so on. Last month I fell back off our metal garage pull down ladder 8' to 10' up going into a attic with a aluminum ramp. My left foot got caught in one of the rungs as I fell back swung like a pedulum back and to my right hitting my head in a metal bar above the right eye stitches were required. I went by ambulance as a trauma kept over night for observation unfortunately my left foot / ankle has lots of damage still healing on crutches/ walker. The swelling on the ankle was so bad large blisters formed on both sides was told it comes from the anticoagulant medicine 💊. Fortunately at the head all ok no brain bleed but on the foot ankle all he'll broke out with the blood pooling. It could of been the other way around yet for the life of me I can't understand why it wasn't and gratefully except this outcome.