Warfarin and Altitude

[rogergorman]

Does anyone know if it's safe to walk at altitude while being on Warfarin? I am hoping to do the Everest Base Camp trek which includes a fortnight of walking over 3000m to 5500m. A have APS and had a blood clot on the brain in 2013 which resulted in lasting double vision. This is corrected with prism glasses. My INR remains steady between 2-3. I am 66 but generally fit and do lots of walking in the English Lake District and in Europe.

[Lure2]

Hi Rogergorman,

That is really not bad at the age of 66 and with APS!

I can not say anything on the altitude-problem contra Warfarin but I hope you have got a Specialist of autoimmun illnesses who knows this. Ask hen.

Also your INR is probably quite too low. You definitely need an INR over 3.0 to be safe. 2.0 is out of the question for us with APS.

Most of us need an INR between 3.5-4.0.

Also as to your lasting doublevision it went away for me with a higher INR over 3.5. I suggest you selftest at Mount Everest.

Good luck with the project! Please tell us what your Specialist say about it as it could be interesting to know how or if the altitude will alter the INR.

Kerstin in Stockholm

[rogergorman in reply to Lure2]

Thanks Kerstin...I'll keep you updated.

[InSpain]

Definitely a question for your APS Specialist.

The Everest base camp trek sounds great. Do hope you get to do it.

[rogergorman in reply to InSpain]

Thanks InSpain...I'll keep you updated.

[KellyInTexas Administrator]

I would be prepared to have the following information readily available to answer for yourself and your APS specialist:

1. Will a medic be along on the hike? This is not uncommon.

2. Will oxygen be packed with Sherpas/ pack mules? This is not unheard of.

3. In general, what is the standard operatin procedures in place for medical emergencies? Time of response? Closest facilities by airlift?

( I assume this hike is arranged by a professional and you will be with trusted friend(s)?

[rogergorman in reply to KellyInTexas]

Thank you KellyInTexas

My prepared answers are:

1 Possibly!

2 Yes usually...

3 Uncertain - airlift to Katmandu...

With professionals and trusuted friends

[Ray46]

I did some research on this a while ago and altitude is definitely known to affect INR, tending to lower it, see e.g.: ncbi.nlm.nih.gov/pubmed/165...

And then high altitude is also know to make vascular system more prone to clots see pdfs.semanticscholar.org/07...

Before warfarin I used to ski and stay at resorts >2000m, never had any altitude problems except very slight headache at >3000m. Since warfarin I have tended to stay lower and lower resorts means less time >3000m - and I have had no problems so far. I have had no INR problems either, however I do self-test every two days when skiing to make sure (also tend to drink more wine to make sure it doesn't go low, no other reason ).

3000-5000m for two weeks is a lot more altitude though (and I wouldn't recommend the more wine approach to INR there either). If you aren't self-testing already I would say you need to plan to do it on the trip and for several months before - testing labs are likely a bit sparse up there. I would probably test every day, at least at first, maybe every two days once acclimatised, and ideally you want to have the ability (and authority) to adjust your own dose - phoning the clinic might be tricky and/or expensive.

Is it safe? - see if you can get insurance or not. Is it something you really want to do is the real question. There is always a balance between just staying alive and carrying on living. No one is telling me I can't ski, or if they have I didn't hear or remember it (my finances tell me how often, obviously ).

[rogergorman in reply to Ray46]

That's very sound advice. Thank you for taking the time and trouble. I'll keep you updated - I see my GP on Weds but I think I need more specialist advice than that!

[GinaD]

Let us know how the trip goes. Whhen I was diagnosed in 2001 I was told to avoid high altitudes. The only post warfarin clot I had ( very minor, until having my memory jogged by your post I had forgotten,) in 2003 happened when hiking at a 4000 foot level --far lower that Nepal! I was also bckpacking, which means

i had pressure on brachial arteries. AND on my feet a lot. My hematologist at that time was sure that elevation had a role. ( NB, local elevation id 200-1000 feet.) I no longer consult with that out-of-state hematologist, and we have learned a lot more about the disease in the interum.

[rogergorman]

Many thanks GinaD - I'll keep you posted.

[orygun66]

I have been on warfarin for 7 years and live at 6000 feet in Colorado. I've been as high as 14,000 feet though not for any long hikes or anything like that. I have not had any problems related to elevation other than my need for oxygen. Have fun on your trip!

[rogergorman]

Thanks for your encouraging response....