Haemorrhage/Hemorrhage Risk

Does anyone know if there are definite INR levels at which haemorrhage becomes a real concern? Additionally, what activities can lead to haemorrhages and where might they occur?

I ask, because I am quite physically active. I workout daily, often lifting heavy weights. I know that some powerlifters experience nosebleeds when lifting extremely heavy weight. I was concerned that such levels of exertion could cause bleeding elsewhere in the body as well.

I am not a powerlifter but I do workout intensely. No contact sports of any kind (I was warned about those), but I really do push it at the gym. Should I be more careful or is exercise regardless of level of intensity OK?

10 Replies

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  • Of course if your INR goes above your theraputic dose you have an increase possibility of bleeding and the higher it is then the higher the risk.

    But I have to tell you that I refuse to let my INR status stop me from living my life. Now, I do not get on motorcycles as it is risky anyway and with my thin blood it would be a huge risk--BUT--I do not let it stop me from climbing a rock which I love to do. It does not stop me from living my life. THe only sport I would avoid IF I played sport games would be tackle football.

    I keep my INR between 3-4 for best health. I love to swim. I homeschool so I participate with the kiddos in our exercises for PE which include jumping jacks, toe touches etc. I cannot do intense exercises as since all my issues w/ pulmonary emboli I become to short of breath.

    I personally do not concern myself with all sorts of safety concerns. I live dangerously using a razor to shave (lol). Since you are concerned about the intensity I would discuss it with the doctor and be honest about how intense you exercise --get their guidance. Of course the nurse at my doc says ''what don't you get about coumadin and rock climbing" I respond with--"what don't you get about living life"

  • It's all down to individulas and their reaction to Warfarin, i don't feel there is a definitive level.

    I personally have had INR'S in the 10's with no problem and even when I had an INR of 17 only had a slight nose bleed. Lucky I guess. as others have had probs with much lower INR'S

  • anything above 8 is conisdered unclottable but I would say 5 would certainly be a risk as well. I have seen a few bleeds very serious.

    Bethanne- you are so lucky- I have seen a person bleeding from all orifices and into eyes with an INR Of 17! We probably didn't need to do a labdraw as the urine probably would have done just fine!

    If you are going to take risks regardless- do it calculated, know those risks. Pay close attention to your INR fluctuations, your diet and all that. Know what it takes to normalize your INR fastest. Get to know your "feelings" of being too high if there are any. Let the people at the gym know how to treat a severe bleed and what to do in case of emergency.

    Be careful and don't overdo it, I won't preach risks, just be reasonable.

    Glad to see someone with such a passion for health.

  • Hey girly,

    Re-read that. I am NOT the one w/ INR of 17. I would be one sick pup it that happened to me. Your APS brain messed mixed you up.

    An INR of 8 is noticable for me. I never go over therautic now that I have my machine.

  • LOL I think I messed that up a bit!! Been under some serious stress lately...

  • Hiya,

    Have to echo Bethanne's view - be sensible re INR checks, avoiding higher risk food items and then live life to the full. I had a brain subdural haemorrhage (due to a combination of high INR linked to warfarin & being prescribed non-steroidals at the same time), but I would say that the main risk to us is clotting.

    I still go kayaking and end up with some impressive bruises when I regularly capsize (coz the rivers are better than me!) but it's what I enjoy doing, so that's what I do.

    Please don't let worry stop you doing what you enjoy - have you had any bleeds through doing power lifting before? My understanding is that thinner blood doesn't increase the risk of bleeding, it just means you bleed more / for longer when you do, but would be interested to know others thoughts on this?

  • Its good to read about the exciting life that you lead despite having APS, I am trying to get my head into gear about this, having suffered a severe nosebleed 3 years ago (due to low platelets and not on Warfarin) this has affected me!!! Unfortunately for me I find that when my INR goes high then a nosebleed and blood spots in mouth. I had to cancel a facial the other week in fear of the therapist massaging on the face causing me to bleed. Also last Friday, decided to do something really daring - I fell down the stairs as was thinking of so many things, and ended up with cracked ribs and a whopping great big bruise on my left side arm. I really want to get into doing things for me, not allowing warfarin to govern my life!!!! I went today for check and its 4.3 hence the nosebleeds and now have to wait for the dosing this pm.

    What was your symptoms of the brain Haemorrhage?

    I did not go to A & E on the evening I fell, but in the morning, my sides were so bad that I did and they kept saying was it due to being dizzy etc, but I can honestly say it wasn't due to being dizzy but having so many things going on. I dread going to hospitals as one has to explain over and over and over again the medical history. Because of this I have now put in a small note which my husband keeps in his wallet so everything is all there such as medication, doctors, allergies, medical problems etc, it all helps.

    Anyway now I am going to wait for the phone to ring!!! exciting

    PS Do you drive? My GP who is very over protective advised me not to drive approx 2 years ago and this has had a huge impact on my life and having to rely on hubby.

  • Daisy,

    Yes I drive. I homeschool my grandchildren, I work two days per week (24hrs/wk) in a fast pace job. I camp, I hike, I fish, I swim. I do not rely on anybody. Maybe some day I will be too impaired to do something but as long as I can I will do my life.

    I do not lead an exciting life. A year ago Seresa and I took a trip to D.C. for the week and we walked for miles and miles. We ached but did it again each day.

    Some days I can only do a bed but those are far and few between for me. I flare about once per year and it will take me out for 30-40 days at a time but then I go back at it again.

    I use to have a housekeeper but financial issues changed and I lost her. So my house is not spotless any longer.

  • I have been on warfarin for a long time and what I have learned is mostly a high INR is safe except when you could bleed internally or externally.

    INR of 5 means your blood takes 5 times longer to form a clot and that means it takes 5 times longer to stop bleeding.

    So if you had a high INR and you were in a bad accident you could bleed to death, but if you were not in an accident you would be fine. If you cut yourself with a razor or working with sharp tools it would be a small cut so as long as you gave yourself first aid you would be ok.

    If you had an ulcer or similar it could be dangerous.

    Contact sports are risky because of risk of internal bleeding.

    Personally I stopped going to the gym because I had a seizure and went unconscious one day and fortunately I was with other people, I got taken to hospital and put in the CT scanner and they found I had a subdural haematoma. My doctors could not explain why it was there as I had not banged my head. Also once I had a really high INR and I was told if I sneezed my brain could bleed.

    Its up to you what you do but be aware if you go on expeditions excess danger to you could have an effect on those around you, if they had to take care of you in an accident or also any issues with health and safety risk assessments that could be done.

  • If you do a search on "warfarin protocol" you will get the guidance to medics about how to work with warfarin and INR and apparently if an INR is above 5 they consider it dangerous and will take action.

    My consultant has put in writing that 5 is the upper limit.

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