You might want to have a chat with your doc about warfarin vs doac reversibility - vitamin k takes about 12 hours to reverse warfarin. In a life threatening situation most doacs can be reversed in about 5 minutes.
Blood Thinners and Biking
- Thread starter Cowlitz
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You might want to have a chat with your doc about warfarin vs doac reversibility - vitamin k takes about 12 hours to reverse warfarin. In a life threatening situation most doacs can be reversed in about 5 minutes.
Comfortably Numb
Well-Known Member
I have been on Warfarin for almost 11 years.
I had a pretty bad stroke (my second of three) in 2007. Basically I had to learn to walk again, my balance and coordination was so bad. I have no foot speed, so I can't run and I hence, bike for cardio. I had a pulmonary embolism in 2010 so my lungs are not great. Last week was the first time I've gotten up, out of the saddle in years and years, but for the most part my balance is not bad once I get on a bicycle or a motorcycle. With me it's my lousy lung function.
I am always cutting myself, and always did at work, and I'm guessing only the odd one takes, or took a little longer to clot. Most of the time I don't even give it any thought. I have learned the physical signs to 'know what my INR is roughly' day to day and get it tested monthly.
This thread is the first time I've heard of anyone getting bruised easily. No bruising here.
I don't think any different than I ever have about my safety riding a bike. I worry far more about traffic hazards than I do the chance of a health problem on a ride. I can't contribute anything towards anyone's risks physically. They're rightfully on their own with their doc. CN
I had a pretty bad stroke (my second of three) in 2007. Basically I had to learn to walk again, my balance and coordination was so bad. I have no foot speed, so I can't run and I hence, bike for cardio. I had a pulmonary embolism in 2010 so my lungs are not great. Last week was the first time I've gotten up, out of the saddle in years and years, but for the most part my balance is not bad once I get on a bicycle or a motorcycle. With me it's my lousy lung function.
I am always cutting myself, and always did at work, and I'm guessing only the odd one takes, or took a little longer to clot. Most of the time I don't even give it any thought. I have learned the physical signs to 'know what my INR is roughly' day to day and get it tested monthly.
This thread is the first time I've heard of anyone getting bruised easily. No bruising here.
I don't think any different than I ever have about my safety riding a bike. I worry far more about traffic hazards than I do the chance of a health problem on a ride. I can't contribute anything towards anyone's risks physically. They're rightfully on their own with their doc. CN
PatriciaK
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I think they infuse Adexxa (sp?) now for serious bleeding with Xarelto/Eliquis. Works pretty quick.
My first DVT/PE episode occurred while traveling overseas and I ended up in a hospital in Greece (excellent care, BTW) for a week (the whole shebang cost $800, total!) for treatment. When they began giving me oral medication for the clots, I asked if it was warfarin... The nurse laughed at me and said they hadn't used that in years, that they used Xarelto now (2014). She also said it was very expensive - the equivalent of $90 per month (it cost like 4 times that here in the good old USA when I got home). I was on that for 6 months, then stopped for a few years until my second PE episode about 3 years ago; have been on it again ever since. I love being able to eat whatever I want, whenever I want, and not having to get a needle stick every month.
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You might want to check the actual clinical data. The data I've seen shows that Xarelto is far better at avoiding brain bleeds (strokes) than Warfarin. That's one reason why many health/drug plans cover it, and prefer it.
Of course Xarelto does have a big downside: You loose those wonderful, frequent visits to a health care provider to have your finger stuck for an INR test! Maybe your provider offers free coffee and donuts?
Dallant
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Then take them at home. Takes about two minutes twice a month.
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Yes, finger sticks and a much higher stroke risk. A great choice for folks to take...
I'm intrigued, how do you convince the significant other to dress up, do the finger prick thing, and not notice that the coagucheck isn't reading the doac response? Lucky man....
They have the same stroke risk, just a lower brain bleed risk ( and higher gi bleed risk ) .
Dallant
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There are some reasons not to take Xarelto…
WARNINGS AND PRECAUTIONS
- Increased Risk of Thrombotic Events after Premature Discontinuation: Premature discontinuation of any oral anticoagulant, including XARELTO®, in the absence of adequate alternative anticoagulation increases the risk of thrombotic events. An increased rate of stroke was observed during the transition from XARELTO® to warfarin in clinical trials in atrial fibrillation patients. If XARELTO® is discontinued for a reason other than pathological bleeding or completion of a course of therapy, consider coverage with another anticoagulant.
- Risk of Bleeding: XARELTO® increases the risk of bleeding and can cause serious or fatal bleeding. Promptly evaluate any signs or symptoms of blood loss and consider the need for blood replacement. Discontinue in patients with active pathological hemorrhage.
- An agent to reverse the anti-factor Xa activity of rivaroxaban is available. Because of high plasma protein binding, rivaroxaban is not dialyzable.
- Concomitant use of other drugs that impair hemostasis increases risk of bleeding. These include aspirin, P2Y12 platelet inhibitors, dual antiplatelet therapy, other antithrombotic agents, fibrinolytic therapy, NSAIDs, selective serotonin reuptake inhibitors (SSRIs), and serotonin norepinephrine reuptake inhibitors (SNRIs).
- Risk of Hemorrhage in Acutely Ill Medical Patients at High Risk of Bleeding: Acutely ill medical patients with the following conditions are at increased risk of bleeding with the use of XARELTO® for primary VTE prophylaxis: history of bronchiectasis, pulmonary cavitation, or pulmonary hemorrhage; active cancer (ie, undergoing acute, in-hospital cancer treatment); active gastroduodenal ulcer or history of bleeding in the three months prior to treatment; or dual antiplatelet therapy. XARELTO® is not for use for primary VTE prophylaxis in these hospitalized, acutely ill medical patients at high risk of bleeding.
- Spinal/Epidural Anesthesia or Puncture: When neuraxial anesthesia (spinal/epidural anesthesia) or spinal puncture is employed, patients treated with anticoagulant agents for prevention of thromboembolic complications are at risk of developing an epidural or spinal hematoma, which can result in long-term or permanent paralysis. To reduce the potential risk of bleeding associated with concurrent use of XARELTO® and epidural or spinal anesthesia/analgesia or spinal puncture, consider the pharmacokinetic profile of XARELTO®. Placement or removal of an epidural catheter or lumbar puncture is best performed when the anticoagulant effect of XARELTO® is low; however, the exact timing to reach a sufficiently low anticoagulant effect in each patient is not known. An indwelling epidural or intrathecal catheter should not be removed before at least 2 half-lives have elapsed (ie, 18 hours in young patients aged 20 to 45 years and 26 hours in elderly patients aged 60 to 76 years), after the last administration of XARELTO®. The next dose should not be administered earlier than 6 hours after the removal of the catheter. If traumatic puncture occurs, delay the administration of XARELTO® for 24 hours. Monitor frequently to detect signs or symptoms of neurological impairment, such as midline back pain, sensory and motor deficits (numbness, tingling, or weakness in lower limbs), or bowel and/or bladder dysfunction. Instruct patients to immediately report any of the above signs or symptoms. If signs or symptoms of spinal hematoma are suspected, initiate urgent diagnosis and treatment including consideration for spinal cord decompression even though such treatment may not prevent or reverse neurological sequelae.
- Use in Patients with Renal Impairment:
- Nonvalvular Atrial Fibrillation: Periodically assess renal function as clinically indicated (ie, more frequently in situations in which renal function may decline) and adjust therapy accordingly. Consider dose adjustment or discontinuation in patients who develop acute renal failure while on XARELTO®. Clinical efficacy and safety studies with XARELTO® did not enroll patients with CrCl <30 mL/min or end-stage renal disease (ESRD) on dialysis.
- Treatment of Deep Vein Thrombosis (DVT), Pulmonary Embolism (PE), and Reduction in the Risk of Recurrence of DVT and of PE: In patients with CrCl <30 mL/min, rivaroxaban exposure and pharmacodynamic effects are increased compared to patients with normal renal function. There are limited clinical data in patients with CrCl 15 to <30 mL/min; therefore, observe closely and promptly evaluate any signs or symptoms of blood loss in these patients. There are no clinical data in patients with CrCl <15 mL/min (including patients on dialysis); therefore, avoid the use of XARELTO® in these patients. Discontinue XARELTO® in patients who develop acute renal failure while on treatment.
- Prophylaxis of Deep Vein Thrombosis Following Hip or Knee Replacement Surgery: In patients with CrCl <30 mL/min, rivaroxaban exposure and pharmacodynamic effects are increased compared to patients with normal renal function. There are limited clinical data in patients with CrCl 15 to <30 mL/min; therefore, observe closely and promptly evaluate signs or symptoms of blood loss in these patients. There are no clinical data in patients with CrCl <15 mL/min (including patients on dialysis); therefore, avoid the use of XARELTO® in these patients. Discontinue XARELTO® in patients who develop acute renal failure while on treatment.
- Prophylaxis of Venous Thromboembolism in Acutely Ill Medical Patients at Risk for Thromboembolic Complications Not at High Risk of Bleeding: In patients with CrCl <30 mL/min, rivaroxaban exposure and pharmacodynamic effects are increased compared to patients with normal renal function. There are limited clinical data in patients with CrCl 15 to <30 mL/min; therefore, observe closely and promptly evaluate any signs or symptoms of blood loss in these patients. There are no clinical data in patients with CrCl <15 mL/min (including patients on dialysis); therefore, avoid the use of XARELTO® in these patients. Discontinue XARELTO® in patients who develop acute renal failure while on treatment.
- Reduction of Risk of Major Cardiovascular Events in Patients with Chronic CAD or PAD: For patients with CrCl <15 mL/min, no data are available, and limited data are available for patients with a CrCl of 15 to 30 mL/min. In patients with CrCl <30 mL/min, a dose of 2.5 mg XARELTO® twice daily is expected to give an exposure similar to that in patients with moderate renal impairment (CrCl 30 to <50 mL/min), whose efficacy and safety outcomes were similar to those with preserved renal function. Clinical efficacy and safety studies with XARELTO® did not enroll patients with end-stage renal disease (ESRD) on dialysis.
- Use in Patients with Hepatic Impairment: No clinical data are available for patients with severe hepatic impairment. Avoid use in patients with moderate (Child-Pugh B) and severe (Child-Pugh C) hepatic impairment or with any hepatic disease associated with coagulopathy, since drug exposure and bleeding risk may be increased.
- Use with P-gp and Strong CYP3A Inhibitors or Inducers: Avoid concomitant use of XARELTO® with known combined P-gp and strong CYP3A inhibitors or inducers.
- Risk of Pregnancy-Related Hemorrhage: In pregnant women, XARELTO® should be used only if the potential benefit justifies the potential risk to the mother and fetus. XARELTO® dosing in pregnancy has not been studied. The anticoagulant effect of XARELTO® cannot be monitored with standard laboratory testing. Promptly evaluate signs or symptoms suggesting blood loss (eg, a drop in hemoglobin and/or hematocrit, hypotension, or fetal distress).
- Patients with Prosthetic Heart Valves: Use of XARELTO® is not recommended in patients who have had transcatheter aortic valve replacement (TAVR), based on the results of the GALILEO study, which reported higher rates of death and bleeding in patients randomized to XARELTO® compared to those randomized to an antiplatelet regimen. Safety and efficacy of XARELTO® have not been studied in patients with other prosthetic heart valves or other valve procedures. Use of XARELTO® is not recommended in patients with prosthetic heart valves.
- Acute PE in Hemodynamically Unstable Patients/Patients Who Require Thrombolysis or Pulmonary Embolectomy: Initiation of XARELTO® is not recommended acutely as an alternative to unfractionated heparin in patients with pulmonary embolism who present with hemodynamic instability or who may receive thrombolysis or pulmonary embolectomy.
- Increased Risk of Thrombosis in Patients with Antiphospholipid Syndrome: Direct-acting oral anticoagulants (DOACs), including XARELTO®, are not recommended for use in patients with triple-positive antiphospholipid syndrome (APS). For patients with APS (especially those who are triple positive [positive for lupus anticoagulant, anticardiolipin, and anti-beta 2-glycoprotein I antibodies]), treatment with DOACs has been associated with increased rates of recurrent thrombotic events compared with vitamin K antagonist therapy.
- Combined P-gp and strong CYP3A inhibitors increase exposure to rivaroxaban and may increase risk of bleeding.
- Combined P-gp and strong CYP3A inducers decrease exposure to rivaroxaban and may increase risk of thromboembolic events.
- XARELTO® should not be used in patients with CrCl 15 to <80 mL/min who are receiving concomitant combined P-gp and moderate CYP3A inhibitors (eg, erythromycin) unless the potential benefit justifies the potential risk.
- Coadministration of enoxaparin, warfarin, aspirin, clopidogrel, and chronic NSAID use may increase risk of bleeding.
- Avoid concurrent use of XARELTO® with other anticoagulants due to increased bleeding risk, unless benefit outweighs risk. Promptly evaluate signs or symptoms of blood loss if patients are treated concomitantly with aspirin, other platelet aggregation inhibitors, or NSAIDs.
- Pregnancy: The limited available data on XARELTO® in pregnant women are insufficient to inform a drug-associated risk of adverse developmental outcomes. Use XARELTO® with caution in pregnant patients because of the potential for pregnancy-related hemorrhage and/or emergent delivery. The anticoagulant effect of XARELTO® cannot be reliably monitored with standard laboratory testing. Consider the benefits and risks of XARELTO® for the mother and possible risks to the fetus when prescribing to a pregnant woman.
- Fetal/Neonatal adverse reactions: Based on the pharmacologic activity of Factor Xa inhibitors and the potential to cross the placenta, bleeding may occur at any site in the fetus and/or neonate.
- Labor or delivery: The risk of bleeding should be balanced with the risk of thrombotic events when considering use in this setting.
- There are no adequate or well-controlled studies of XARELTO® in pregnant women, and dosing for pregnant women has not been established. Post-marketing experience is currently insufficient to determine a rivaroxaban-associated risk for major birth defects or miscarriage.
- Lactation: Rivaroxaban has been detected in human milk. There are insufficient data to determine the effects of rivaroxaban on the breastfed child or on milk production. Consider the developmental and health benefits of breastfeeding along with the mother’s clinical need for XARELTO® and any potential adverse effects on the breastfed infant from XARELTO® or from the underlying maternal condition.
- Females and Males of Reproductive Potential: Females of reproductive potential requiring anticoagulation should discuss pregnancy planning with their physician. The risk of clinically significant uterine bleeding, potentially requiring gynecological surgical interventions, identified with oral anticoagulants, including XARELTO®, should be assessed in females of reproductive potential and those with abnormal uterine bleeding.
- Pediatric Use: Safety and effectiveness in pediatric patients have not been established.
- Overdose of XARELTO® may lead to hemorrhage. Discontinue XARELTO® and initiate appropriate therapy if bleeding complications associated with overdosage occur. An agent to reverse the anti-factor Xa activity of rivaroxaban is available.
- Most common adverse reactions with XARELTO® were bleeding complications.
PatriciaK
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I like Xarelto and it works very well for me, which does not mean that Xarelto is good for everyone, or that everyone should switch to Xarelto. No need to get into a peeing contest about what blood thinner is "best" 
. This is like how everyone likes their own bike, and many recommend their bike even to people who may have different needs...
I think the point of this thread is, just because you're in a blood thinner does not mean you have to give up riding your bike. It depends on what kind of riding you do, how comfortable you are with the risks involved, how prepared you are in case of injury, and, most of all, what you and your doctor decide together. Many of us ride even though we take these meds, but others may choose not to, or may not be able to. It's all good - we're all different
.
. This is like how everyone likes their own bike, and many recommend their bike even to people who may have different needs...I think the point of this thread is, just because you're in a blood thinner does not mean you have to give up riding your bike. It depends on what kind of riding you do, how comfortable you are with the risks involved, how prepared you are in case of injury, and, most of all, what you and your doctor decide together. Many of us ride even though we take these meds, but others may choose not to, or may not be able to. It's all good - we're all different
.
DaveMatthews
Well-Known Member
I've been on Warfarin for years as well after a DVT.
To me bashing or cutting myself is just living.
To me bashing or cutting myself is just living.
Your point? You will find similar lists for other anticoagulants. The drug label says nothing about how similar drugs compare, unless you did into the section that summarizes clinical trial results, and they used a comparator drug, which is not often the case.
Give me a break. I spent a career in biomedical research management, including vaccine development. Lots of experience with clinical trial management too.
You have any biomedical experience? Didn't think so. Maybe you should stick to bikes, which you appear to know better?
Dallant
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Point is people take what doctors prescribe based on their condition and situation. For you and others to sit here berating people is BS.
Evidently you believe anyone who disagrees with you, or presents factually based alternative opinions, is "berating" you? Have you considered therapy?
I'll bow out of this discussion...but I still respect your bicycle opinions.
tomjasz
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Most designer drugs have incredible contraindications.
Comfortably Numb
Well-Known Member
I'm almost never disappointed when I click to view posts from people I have on Ignore.
The vast majority of the time it just confirms ignoring them was the right idea, although I miss a lot of the p****ng matches like in this thread. Boy, some people sure have a lot of free time.
CN
The vast majority of the time it just confirms ignoring them was the right idea, although I miss a lot of the p****ng matches like in this thread. Boy, some people sure have a lot of free time.
CN
Catalyzt
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Yes, and I personally am at greater risk for a GI bleed, as I have had one already-- and that was part of my decision making process for sure, thanks, important point. (Though I think Warfarin can be reversed in under 15 minutes-- it depends how you are administering the Vitamin K.)
I did not mean to imply that my choice is the right one for everyone, but the relative risks of anticoagulants are also really hard to assess. RCT's are also fiendishly difficult to understand and interpret, and lots of people a lot smarter than me wonder if they really should be "the gold standard" for evaluating the relative efficacy of pharmacological agents. RCTs are fantastic if you are measuring a really clear outcome in a well-defined patient population-- like viral load in HIV patients.
But when there are many, many different potential adverse outcomes that may vary greatly in different populations, I think it's important to look at RCTs with a more critical eye-- that doesn't mean ignoring them, it means also considering studies with smaller, clearly-defined samples, and also just asking medical professionals what they see in their practice.
No disrespect to anyone who uses non-Vitamin K anticoagulants, I know they are a great choice for lots of people, and many factors influence the choice. Part of the reason Warfarin works for me is that I'm only a 7 minute drive from my health care provider. One Canadian biker in my online DVT support group who lived in a remote area was able to ride again for the first time when the non-Ks came on the scene-- more power to him, I have nothing against them. Yes, I am a little suspicious of the same dose of anticoagulant for all patients irrespective of body weight, but that's only one of many factors I would consider, and it's a speculative one, so I wouldn't-- and didn't-- base my decision solely on that.
Here's a smaller study that suggests the issue is not so cut-and-dried for AFIB patients:
Effectiveness and Safety of Standard-Dose Nonvitamin K Antagonist Oral Anticoagulants and Warfarin Among Patients With Atrial Fibrillation With a Single Stroke Risk Factor: A Nationwide Cohort Study - PubMed
In this Danish cohort study of patients with atrial fibrillation and a single stroke risk factor, there was no difference between NOACs compared with treatment with warfarin in terms of the risk of having an ischemic stroke/systemic embolism. For "any bleeding," this was lower for treatment with...
pubmed.ncbi.nlm.nih.gov
Here's another one that looks at an older population. Again, it depends what the endpoint is-- combining critical and noncritical bleeding events for this population, Warfarin actually edges out Xaltero, but looking at other endpoints, Xaltero is slightly safer.
Use of XARELTO in the Elderly
A summary of clinical data regarding XARELTO® (rivaroxaban) use in elderly patients.
www.janssenmd.com
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A blood thinner can result in dizziness which could be a problem on a bicycle. If she takes her meds with dinner then the impact will be greatest when she is not out on her bike. Also important to stay hydrated and maintain blood sugar levels while riding.
With most medications the ability of the body to tolerate them differs for different meds in the same class and with different people. Easy to check the side effects for the different blood thinners and check the amount of variation between them.
Important to know where the blood thinner is processed as some meds are broken down in the kidneys and so NSAIDs should be avoided and others by the liver where Tylenol and alcohol are processed.
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