Coumadin and diving?

[Liveordive]

I am currently taking coumadin to treat a blood clot. Any one ever had any negative experiences or know of any complications? Other than sharp objects of course...

[DocVikingo]

There can be negative effects from diving while on anticoagulants.

For example, what might prove to be undetectable or minor bleeding from routine barosqueeze to the ears, sinuses & lungs in the normal diver could result in bleeding with accumulation and tissue damage in the diver on blood thinners. The same holds true for such not uncommon events as falls on the boat, strikes to the body by tanks & dive ladders, and the like.

And, there are those sharp objects that you mention, like those that can be found on some wrecks.

There is also the issue of why such a drug is being taken to begin with. They are often used in hematologic & cardiovascular diseases that in and of themselves could pose dangers to safe scuba. A blood clot with the potential to break free and result in a pulmonary embolism would be among such conditions.

This having been said, there surely are divers on Coumadin who scuba without problem. Absolute keys to diving on blood thinners are the absence of disease that contraindicates diving, proper titration of the medicine & management of its effects, and care by the diver to avoid actions that may trigger troublesome bleeding. Even, then, however some increased level of risk likely remains.

This matter requires careful attention & coordination by both the diver & his or her physician. It also helps if the latter individual has at least a rudimentary knowledge of diving medicine.

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

Best regards.

DocVikingo

[lragsac]

...for some 2 1/2 years now and dive regularly (log 100+ dives/year) without a problem. Of course, I'm monitored closely and test every 2 weeks; sometimes I test every week if I get out of range. I take Coumadin because I have a mechanical heart valve (mitral). When I got back into diving after getting my valve installed I corresponded with Dr. Fred Bove, who referred me via email to Dr. James Caruso, Navy diving medical officer. It was his opinion that it was okay for me to dive, although, as docvikingo also mentioned, it carries some increased risk.

I get minor bangs to my knees and such coming up on the ladder sometimes, but it doesn't seem to be any big deal. Anyway, for what it's worth, this is my personal experience. Yours may be different, but hopefully you'll be able to dive.

[Aeolus]

I have been on Coumadin since Dec '01 and have continued to dive. I had the aortic valve replaced with a mechanical one. I make several dive trips each year and to date, I have had no problem. BE SURE to consult with your doctor before resuming diving.

Good Luck. Dive Safe and Dive Often.

[Saturation]

In general, if there are no clinical signs of bleeding such as when brushing teeth, or easy bruising, or nose bleeds and if the INR is therapeutic, coumadin use is acceptable for recreational diving. As a reader stated, there are added risks compared to a diver of normal clotting capacity, but in acute injury hemostasis is caused by platelets and later acted on by the clotting pathways. As diving does not involve substantial trauma, the coumadin patient should pay attention to issues on the surface pre-dive that could increase risk for injury: rough seas, being hit by tanks or weights etc.,

The second issue is why the coumadin is being used in the first place, and that issue could be rate limiting in fitness to dive. It can be given for many conditions such as DVT and PE prophylaxis, hereditary thrombotic disorders, artificial valves etc.,

[DocVikingo]

Now why didn't I think of those things?

Best regards.

DocVikingo

[Saturation]

DocVikingo once bubbled...
Now why didn't I think of those things?

Best regards.

DocVikingo

Hi DocVikingo:

It was just a rephrase of your most detailed post :) A pleasure to chat once again, I'm not diving until Sunday.

Consider too, just for insight. Most coumadin users find their INRs via a needle prick or a blood draw which stops bleeding quite readily, and later we receive sometimes shocking INRs of 8-10. Patient's could be just waiting for that phone call watching TV, probably with a beer in hand they shouldn't be drinking :rolleyes:

The big issue with bleeding is when hemostasis cannot be obtained sufficiently to allow a slow clotting pathway to clot and aide hemostasis, and that is usually intracranial injuries or internal blunt injuries, such as being punched in the abdomen, or suffering a blow to the head. Thus, a boxer on coumadin is a definite no-no while swimming, for the most part is problem free [ unless said swimmer likes to dive in shallow water!]

[miguel sanz]

I agree with what has been said about oral anticoagulants and diving, and I beleive I would dive if I had to take them. There is one thing I want to add, depending on your diving site (wich ideally shouldnīt be far away from a hospital) it would probably be good to carry anti-anticoagulants (of course after discussing it with your physician).

[miguel sanz]

I forgot one thing, even though itīs expensive, itīs probably safer to do INR self-control, since you can know your INR as many times as you want and as close to your diving activities as you want.

[Saturation]

http://www.lifescan.com/company/press/prharmony_launch.html

The jury's still out on that one, but its promising. I am constantly annoyed by coumadin adjustment, its something that, like insulin, should be taught to patients.

[zeN||]

Since embolism is one of the more serious traumas associated with diving, I am curious if any of the docs suggests antocoagulant therapy may in fact be beneficial zeN

[Saturation]

zeN|| once bubbled...
Since embolism is one of the more serious traumas associated with diving, I am curious if any of the docs suggests antocoagulant therapy may in fact be beneficial zeN

Hi Z:

Coumadin is used in emboli caused by blood clots, that of diving is caused by a bubble of gas.

Antiinflammatory agents [motrin, aspirin or hydrocortisone] are controversial during the bends, and generally not recommended.

Taking aspirin while on coumadin, and thus inhibiting the platelets, is relatively contraindicated, it can make one bleed profusely.

[Aeolus]

Saturation once bubbled...
http://www.lifescan.com/company/press/prharmony_launch.html

The jury's still out on that one, but its promising. I am constantly annoyed by coumadin adjustment, its something that, like insulin, should be taught to patients.

I have looked into this a little and the cost is prohibitive for a decent machine. =-)

[zeN||]

Dr. Saturation, thank you, I was not aware that gas embolism was the only type associated with dive injuries zeN

[DocVikingo]

Actually, I do believe that your inquiry bears a bit more discussion.

I'm leaving the office now, so perhaps tonight.

Best regards.

DocVikingo

[Saturation]

zeN|| once bubbled...
Dr. Saturation, thank you, I was not aware that gas embolism was the only type associated with dive injuries zeN

Hi Z,

Its the most common type. You could stroke from exertion [while diving but it could happen with exercise or sex] if one has other diseases that are worsened by exertion such as hardened arteries or aneurysms of the vessels of the brain. When a normal person 'strokes' during a dive its mostly cerebral arterial gas embolism, i.e., CAGE.

[lragsac]

Aeolus once bubbled...


I have looked into this a little and the cost is prohibitive for a decent machine. =-)

This is unfortunate. I own a home monitoring device, distributed by Quality Assurance Services, and it cost around $1,000. But if you are going to be on Coumadin for the rest of your life, as I am, it's worth considering. Presently, I don't use my home machine, because I have an HMO that makes it very convenient for me to test at the lab whenever I want. The thing that keeps me from doing home monitoring is the cost of supplies. At $10 a test, I have little incentive to use it. And, of course, my HMO won't cover the cost of supplies.

[miguel sanz]

I donīt think there is much scientific demonstration about the good or bad effects of oral anticoagulants in prevention or treatment of gas emboli (I didnīt have time to chek it on medline, there may be some animal models) but eventhough the gas emboli causes later a blood clot it also causes local tissue lessions that may bleed. Anticoagulants would probably reduce the clot formation around the gas emboli but the bleeding risk would be to high and the patient may need invasive procedures wich would need the coagulation systeme to be normal.
About the INR self- control machines, as I said itīs expensive but it may be cheaper in other countries + it will get cheaper + it depends on how long youīll be on coumadine (for 6 months itīsobviouslly not worth it, but if itīs life long treatment and your young...)+ how much costs a life, or a paralised life? Itīs demonstrated that self control is better (less bleeding and less clot complications), there are basically two problems, 1 the price (national or private inssurances wonīt pay for it by now) and 2 the doctors who live of monitoring INR donīt want to lose it. There is a third problem but I donīt think it applies for divers, itīs about the mental capacity to self manage INR (obviouslly, self itīs not alone, there are teams who will councel you)
Best regards to all those anticoagulated divers out there.

[zeN||]

Thanxs DocViking ~Z