Blood thinners, solo trips, and risking big bleeding

[Doug Coe]

I’ve been prescribed a blood thinner a year ago (Eliquis). I stay almost entirely on trails and rarely slip and fall or get cut, but there’s always the chance of a gash and lots of blood while alone and days from a trailhead.

Would you risk going out for a week alone on a blood thinner? Would you get off it for that week? Would you skip the morning pill and just take the evening pills? (I just discussed this with my cardiologist and he thought those last two options are not crazy, though somewhat risky.)

[Bill Budney]

1) This is probably the wrong place to ask for medical advice.

2) The risk depends on why you take the anticoagulant. Are you considering risking a stroke or heart attack by not taking it, in exchange for some unknown amount of “safety” by clotting naturally?

3) Anticoagulants don’t prevent coagulation, they just slow it down a little. You will still stop bleeding if, for example, you nick a major vessel. You just need to compress the wound longer.

3a) (If that happens then even healthy people risk a heart attack or stroke anyway, but that is generally lower risk than bleeding out.)

One option is to continue taking your med under the assumption that it was prescribed for a good reason, and just keep a QuickClot or BleedStop in your first aid kit, if you’re nervous about it.

 

[Steve Thompson]

My situation may not apply to anyone but me, but I take Xarelto for a genetic clotting disorder (was originally prescribed Eliquis, but insurance stopped covering it) and was given no activity restrictions by my doctor.  Yes, he is aware I am an active hiker I’ll go solo for 1-2 weeks per year in remote off trail areas.

I bruise more easily and bleed a bit longer, but as Bill noted, just compress longer until the bleeding stops.

I have learned that blue shop towels don’t adhere to the clotted wound so I quarter a few and carry them in my 1st aid kit.  If I get a good scuff up (generally shins) I layer a couple over the would, tape in place with leukotape, and keep going.  8 years now, and not yet ready to slow down.

 

[Bruce Tolley]

Doug,

The risk I think is not bleeding from a cut, but the internal bleeding and or hematoma from an  impact or fall. I had one fall XC skiing while on the blood thinner and I more or less crawled with great difficulty off the trail.

[Joey G]

I just watched a YouTube video from a hiker I follow who also takes blood thinners. He talks about it in his video and carries something to help if bleeding occurs. https://www.youtube.com/watch?v=hhzpwcqzZk8

[DWR D]

The big issue is not a cut on your arm or leg; the real big issue is if you fall and hit your head and get a brain bleed… you will be dead.

I have read studies that seem to support a conclusion, that some of these blood thinner therapies for coronary disease result in about as many more deaths from strokes as they save from heart attacks…

I had a similar choice to make and I decided to stop the blood thinkers about a week before a backpack and then start them up again after. My doc approved. Also… I decided to get a prescription for and pack along nitro glycerin to have in the event of a heart attack. Also good idea to take along a Garmin inReach or some such communication device. Disclaimer: I am not a doctor. Pass what ever you decide by your doctor. There are no perfect solutions or strategies… just do what you and your doc thinks best.

 

[jscott]

“I have read studies that seem to support a conclusion, that some of these blood thinner therapies for coronary disease result in about as many more deaths from strokes as they save from heart attacks…”

sorry, no, if I understand you right. This is important! Anti-coagulent meds prevent strokes. This is their whole rationale. They stop clots from forming, primarily in the heart…maybe elsewhere but I’m familiar with heart clots. You definitely don’t  want a blood clot to form in your heart, as when it loosens and enters your brain, you have a stroke. You don’t want a blood clot to  form in your leg or arm either for the same reason.

Picture a thick patch of blood blocking oxygen from entering your brain. etc etc.

Anticoagulant drugs don’t ‘thin’ the blood.  They stop clots from forming. And so yes, bleeding is an issue for folks who take these drugs. Blood clotting stops bleeds.

Anticoagulant drugs aren’t  prescribed unless the patient has risk of stroke. And you really, really don’t want to have a stroke. You also don’t want to bleed out from a serious wound–say, an arterial cut, or even a concussion (risk of internal brain bleeding) etc.

We backpackers tend to prioritize life spent in the wilds. But the majority of our lives are spent with family, work, everyday activities. Losing all of these things due to a stroke would be horrible. this has to be part of the calculation for those who wish to continue wilderness activities while being prescribed so-called ‘blood thinners’. There’s  a good reason for that. Face up to it squarely.

[Bill Budney]

DWR D makes a good point about brain bleeds. They can do as much damage as an ischemic stroke from a clot. Like strokes, a brain bleed may or may not kill you; may or may not do permanent damage. And, yes, I would fear a brain bleed more than bleeding from a cut (which can be stopped with BleedStop or QuickClot).

There’s no way to remove risk entirely.

[jscott]

Bill, you fail to mention the OTHER risks that caused a doctor to prescribe an anticoagulant in the first place. These other risks must exceed that of a brain bleed in order for a doctor  to responsibly prescribe an anticoagulant in the first place.

Yes there’s no way to remove  risk entirely.  But I’ve known folks to hear about ‘brain bleeds’ caused by anticoagulant drugs and refuse to take them, even as their risk from stroke was much, much higher.

[Bill Budney]

Bill, you fail to mention the OTHER risks

Nope. I covered that. Twice.

The point is that there are risks in both directions. You cannot eliminate all of them.

[jscott]

“The point is that there are risks in both directions. You cannot eliminate all of them.”

well, yes, as I also said.  But not all risks are equal. Typically risk for stroke is orders of magnitude higher than risk of brain bleed etc if a patient has been prescribed an  anticoagulant.

To take another example, back in the late  1950’s, taking a polio vaccine carried some risk. Not being vaccinated carried far greater risk. So the benefits outweigh the risks.

Some people might assume that the risks from anticoagulants  are  the same as not taking them. Again, this can be a  dangerous conclusion to make.

[Diane “Piper” Soini]

My boyfriend was taking Eliquis because he had a heart valve replaced. He was told if he hits his head on anything, even on the freezer door in the kitchen, he needs to call 911 immediately because he could get a brain bleed really easily. He went for a walk in the park in our neighborhood and slipped and fell on his hip. By the time he got home he had a bump on his hip the size of a baseball. After a few days almost half his body was deep blood read. This scared him and he carries his Zoleo everywhere now. He’s very sensitive to medication and has a really hard time getting doctors to give him smaller doses of things. This affected the quality of his life so much he found out he can get a device implanted in his heart that would allow him to get off the Eliquis. He got the device and now he doesn’t have to take it anymore. No more problems with huge hematomas but all of this scared him enough he never goes into the wilderness overnight anymore.

[DWR D]

“has a really hard time getting doctors to give him smaller doses of things.”

Most doctors these days are employed by HUGE corporations who’s lawyers put limits on what doctors can do. If a doc won’t agree to reduce the dose of a med I am having side effects from, I cut them in half… I view a doctor as my medical consultant; not the ultimate decision maker.

[Doug Coe]

Thanks for all the input.

For background, I have only very occasional, mild a. fib. The blood thinner is a precaution against a blood clot. My cardiologist said the other day he’d like me to stay on it forever (he hates seeing the occasional patient with a bad stroke).

Bill B.—That’s what I think I’m going to do: keep taking the blood thinner and carry some clot-helping stuff in my FAK.

Steve T.—Nice tip on the blue shop towels. I might try that.

Bruce T.—Hmm. Score one for maybe suspending the blood thinner for the trip. I don’t plan to have internal bleeding, but who does, right?

Joey G—That’s a long video. I’ll finish watching it a bit later. Thanks for the link.

DWR D—If I’m dead…I’ll have no worries!

jscott–Thanks for the info.

[jscott]

“Most doctors these days are employed by HUGE corporations who’s lawyers put limits on what doctors can do. ”

Ummm, no. that’s not my experience. And pretty cynical.  That  goes along with saying that all  journalists are bought off and only report what their masters tell them: that is, a hidden cabal of billionaires who really run the show. Not true. There are plenty of good doctors and journalists on the ground who do very good work indeed. IME doctors look after the interests of their patients, one on one. Yes, with caveats! I have Kaiser. I had to learn how to manage their managers to get the best care. So it goes.

[edited – MK]

[d k]

Doug, A-fib can be worse at altitude, as you’ve probably been told.  Another thing to consider in weighing the pluses and minuses.

[jscott]

here’s a not  terribly definitive short discussion of the topic on the site Stopafib. I post it only to  underline that even doctors disagree among  themselves as to best  protocol.

 

https://forum.stopafib.org/topic/9952-jim/

[Diane “Piper” Soini]

I think they just don’t believe him that he’s very sensitive to medication. Every kind of medication hits him super hard. Not all pills can be cut in half, and he doesn’t like to not follow doctors’ instructions. I don’t know what Eliquis looks like so I can’t say if you can cut it in half or not.

[Jerry Adams]

https://polarbearmeds.com/can-you-safely-cut-eliquis-in-half-dosage-guidelines-and-safety-precautions/

they make 5mg and 2.5mg versions of eliquis

they have a coating that protects the medicine so if you split it in half, use the other half within 24 hours

these are questions to ask your doctor : )

[Bill Budney]

Diane: Maybe ask for a referral to a vascular specialist?

Eliquis is not scored for easy splitting. Coumadin/warfarin is a different anticoagulant that is meant to be titrated, with appropriate testing readily available. It is old school, but has the advantage that it can be quickly reversed by an ambulance crew or ER. The newer meds like Eliquis cannot be reversed, but have a shorter half life. The newer meds are popular because they don’t REQUIRE routine testing as Coumadin does. Tradeoffs.

Ask your doctor about the alternatives.

[Jerry Adams]

its hard to get the dose of warfarin and what you’re eating at the right level to be effective without causing bleeding.  You have to get your blood tested frequently.

eliquis much easier to use

[Larry Swearingen]

I can speak to both ends of this spectrum a bit.  I am now 78 years old and have high blood pressure controlled with Valsartan. I also take Plavix as an anti-coagulant because I had 2 TIA’s about 1997.

That’s Transient Ischemic Attack or mini-Stroke.  I Stroke is scary. The mini stroke feels just like a full on Stroke (couldn’t walk or talk) except it just lasts for a short time. My second one had me in the hospital overnight for further observation and it took me a few months to fully recover. That’s when I started hiking again after a 20 year layoff.  The TIAs seem to have been caused by uncontrolled high blood pressure as the docs could not find any evidence of blood clots .

About a year and a half ago I was on day 8 of a two week canoe trip in the Boundary Waters in northern Minnesota when I apparently fell in some rocks. I have no memory of the fall. My trip partner helped me back to our camp site. I had a rapidly swelling right black eye and a big gash on the back of my head and bleeding out of my left ear. Nausea and dizzy with ear continuing to put out blood I punched the SOS button on my Garmin inReach.  The Forest Service sent in a seaplane to evac me to the ER in Ely, MN. They sent me down to a hospital in Duluth by ambulance. I had two skull fractures, right orbital (the huge black eye) and left temporal and CT scan showed a brain bleed. Plus the 8 staple gash on the back of my head. So 3 days in ICU and 2 more in a regular ward before releasing me.

I was finally cleared by the Neuro Surgeon (no surgery was necessary) just before Christmas after 5 CT scans total to track the brain bleed.

So as scary as that was I will continue to take my Plavix on my Trips because you have some control over bleeds. Just be careful and don’t fall.

Having a Stroke could be extremely bad. Imaging being trapped in your body and not being able to communicate.  That’s what it felt like for about half an hour.

Larry S

[Diane “Piper” Soini]

I’m not the one taking Eliquis. It was my boyfriend. He got a Watchman put in his heart and doesn’t have to take it anymore.

Apparently when you are a fetus you have a temporary heart and as you grow in the uterus, a real heart forms. The little vestigial heart remains as a small cavity in your heart that can cause slow moving blood that can form a clot. The Watchman is inserted, heart tissue grows around it and blocks the small cavity.

[jscott]

Yes,  the Watchman looks  to be  a really great device. It’s still fairly new. Here’s a discussion of  the latest  iteration of  Watchman.

https://forum.stopafib.org/topic/9817-watchman-flx-pro-anyone-had-this/

[MJ H]

Larry, glad you recovered.  I’m younger, but in hiking alone I worry about a fall that would leave me unable to hit the SOS button.  Not that much, I’m still hiking alone mostly.

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