Is there a doctor in the room?
06-15-2018, 09:16 PM
#16
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Thanks to all that have replied to my post, especially the physicians as their comments were particularly insightful.
My physicians, primarily the hematologist, spent a little time explaining that the real risk while on an anticoagulant like Eliquis was the potential for bleeding on/of the brain as well as the internal bleeding that can be hard to detect until it is too late / getting too late.
What I didn't know was just how much impact or force would be required to cause a problem. Per the responses above, it appears that it might not take all that much to be in a bad way.
Thanks again for your comments, this has helped.
My physicians, primarily the hematologist, spent a little time explaining that the real risk while on an anticoagulant like Eliquis was the potential for bleeding on/of the brain as well as the internal bleeding that can be hard to detect until it is too late / getting too late.
What I didn't know was just how much impact or force would be required to cause a problem. Per the responses above, it appears that it might not take all that much to be in a bad way.
Thanks again for your comments, this has helped.
06-15-2018, 09:33 PM
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Coochas, thank you for your comment and the thoughts about taking a "holiday" or seeking a "bridging" solution - it is an interesting strategy. I know there is a NASCAR driver that has periodically gone on "holiday" but he has an army of doctors and gets paid to race. Neither of those factors applies to me. It appears that I've inherited the clotting condition from my father and at some point, my father's physician took him off of coumadin and he ultimately developed DVT again (though my issue was a PE). So as an uneducated patient, the idea of a "holiday" makes me nervous.
06-15-2018, 10:56 PM
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Just wanted to answer a few of the questions that weren't completely answered above. It takes only very minor trauma to sustain a subdural hematoma when you're on coumadin or eliquis. I had a patient bump his head getting out of the car ( no loss of consciousness, laceration or even a lump on his head) and have life threatening bleeding. Bridging isn't a solution because you're just substituting a short acting injectable anticoagulant for the longer acting pill. Your blood is just as "thin". As far as taking a holiday from full anticoagulation, you're always taking a risk. I had a patient stop coumadin for 5 days for an elective hernia repair and suffer a life changing stroke. You can look up the statistics for the incidence of DVT/Pulmonary embolus/stroke for patients with your clotting disorder who are not treated with anticoagulants and compute your risks. I know I'd be very nervous being in a race car on Eliquis-heck, I wouldn't even ride a bike but everybody looks at the statistics in a different way.
06-15-2018, 11:03 PM
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Just wanted to answer a few of the questions that weren't completely answered above. It takes only very minor trauma to sustain a subdural hematoma when you're on coumadin or eliquis. I had a patient bump his head getting out of the car ( no loss of consciousness, laceration or even a lump on his head) and have life threatening bleeding. Bridging isn't a solution because you're just substituting a short acting injectable anticoagulant for the longer acting pill. Your blood is just as "thin". As far as taking a holiday from full anticoagulation, you're always taking a risk. I had a patient stop coumadin for 5 days for an elective hernia repair and suffer a life changing stroke. You can look up the statistics for the incidence of DVT/Pulmonary embolus/stroke for patients with your clotting disorder who are not treated with anticoagulants and compute your risks. I know I'd be very nervous being in a race car on Eliquis-heck, I wouldn't even ride a bike but everybody looks at the statistics in a different way.
06-15-2018, 11:11 PM
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Just to clarify, when you " bridge" using a short acting blood thinner in place of the longer acting one, you still have to stop the bridging anticoagulant to create a window where your blood is no longer thin. Bridging allows that window to be shorter but you would still have a period of vulnerability.
06-16-2018, 12:19 AM
#24
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Recommendations about using blood thinners have changed so much recently that you may not even NEED to be on a blood thinner. You could ask your doctor(s) whether the need for anticoagulants is truly in line with the latest recommendations based on your risk factors.
For example, in my line of work (OB/GYN) just having a blood clotting disorder does not automatically mean a pregnant woman needs a blood thinner in pregnancy. It's based on risk factors.
furthermore, what is your risk of NOT using an anticoagulant? only you and your physicians can make that determination, but physicians sometimes talk in terms of absolutes. In medicine, there are few absolutes - just risks/benefits
For example, in my line of work (OB/GYN) just having a blood clotting disorder does not automatically mean a pregnant woman needs a blood thinner in pregnancy. It's based on risk factors.
furthermore, what is your risk of NOT using an anticoagulant? only you and your physicians can make that determination, but physicians sometimes talk in terms of absolutes. In medicine, there are few absolutes - just risks/benefits
06-16-2018, 09:51 AM
#25
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There is no reasonable benefit here that outweighs risks. The question of whether one needs anticoagulation or not is up the patient and the physician. I dont we should give our opinion in that regard. As a fellow amateur racer, my strong advice is not to even think about it.
06-16-2018, 10:39 AM
#26
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The OP asked for opinions. Medicine is not an exact science, there will be differences in treatment plans based on multiple factors. However, in the case of being on blood thinners and pursuing activities with small, but real possibilities of traumatic injuries such as tracking a car, I doubt many MDs would encourage partaking in such behavior. But, as I said previously, the discussion of that risk, and how to proceed, is ultimately up to the OP and his physician. As far as bridging, or stopping anticoagulation, it seems that the OP has already had a PE, so the likelihood of stopping anticoag therapy seems low. The risk/benefit ratio of stopping it for a short time for a surgical procedure, etc may be worthwhile, but to do so repeatedly for "elective" track events would be too high for me.
06-16-2018, 11:39 AM
#27
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agreed and well stated.
my point was that some people tend to talk in absolutes without knowing the full story and truly estimating the risks vs benefits. are the risks of racing on anticoagulants worth the benefit of racing? that's a question for the OP to answer
my point was that some people tend to talk in absolutes without knowing the full story and truly estimating the risks vs benefits. are the risks of racing on anticoagulants worth the benefit of racing? that's a question for the OP to answer
06-16-2018, 05:53 PM
#28
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I know its not the same but you could build yourself a very good simulator (probably with some motion), you can enjoy driving and the competition. Again i know you do not get the same feeling but its better than nothing and will not put you at risk.
please note i am not a doctor
please note i am not a doctor
06-16-2018, 06:12 PM
#29
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Interesting discussion as I am also on Eliquis for a DVT after an Acetabular hip fracture. My Trauma surgeon had to replace a screw which had come loose and I asked him about the Eliquis. His reply was don't worry I will deal with it. My out patient surgery to replace the screw went off without a hitch and I stayed on Eliquis the whole time.
Peter
Peter
06-16-2018, 08:42 PM
#30
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Agree with the other docs...don't ever race on a blood thinner.
But, I will offer a diffetent perspective...
The newer blood thinners have fast onset and offset. It is not unusual, under certain circumstances, to hold the blood thinner for 3-5 days for procedures like a colonoscopy. Your risk of clotting is elevated, but brief.
For example, using rough numbers...
Patient with a fib may have a 5% risk of stroke in a year. Anticoagulant decreases risk to 1% a year, but exposes risk of bleeding. Net positive.
The risk of being off the blood thinner is tiny on any given day...
Does that make sense? I wouldn't recommend it, but I could see where a professional racer with millions of income on the line might opt to be off blood thinners while racing... yet take them otherwise.
Its a risk reward calculation.
if you get into an accident on a blood thinner... your risk of death I would imagine is quite dramatic... you could bleed out internally before a chopper ever gets there...
this is not medical advice...there is no doctor patient relationship, and only a fool takes internet advice. Realistically, don't race or do hpde. Risk is too great.
But, I will offer a diffetent perspective...
The newer blood thinners have fast onset and offset. It is not unusual, under certain circumstances, to hold the blood thinner for 3-5 days for procedures like a colonoscopy. Your risk of clotting is elevated, but brief.
For example, using rough numbers...
Patient with a fib may have a 5% risk of stroke in a year. Anticoagulant decreases risk to 1% a year, but exposes risk of bleeding. Net positive.
The risk of being off the blood thinner is tiny on any given day...
Does that make sense? I wouldn't recommend it, but I could see where a professional racer with millions of income on the line might opt to be off blood thinners while racing... yet take them otherwise.
Its a risk reward calculation.
if you get into an accident on a blood thinner... your risk of death I would imagine is quite dramatic... you could bleed out internally before a chopper ever gets there...
this is not medical advice...there is no doctor patient relationship, and only a fool takes internet advice. Realistically, don't race or do hpde. Risk is too great.