Advice required re taking Warfarin and riding/ horses.

[Bespoke1]

Looking for advice please, I have just had third lot of surgery on my knee in last two years, but this time have succumbed to Pulmonary Embolism , Pleural Effusion, Infarct in lung and infection, leg still throwing DVT's at 10 days post op. I have been in and out of various hospitals since op and am now at home, I am now going to be taking Warfarin for min 6 months and all the scary information that comes with it,( if you get a knock internal bleeding , bruising ,head injury a hospital job, if u cut yourself and don't stop bleeding within 10 mins hospital etc etc)
my husband is totally freaked , and says I shouldn't be any where near my 3 horses at all ( my big lad is not the most spacially aware but has improved immensely since I got him ,(did need to wear my hat all the time when I first got him) i accept i will probably need to wear riding hat and body protector a lot more. I can't ride for 3 months anyway and have already organised professional help re care and riding, so has anyone got any advice or tales of how they manage please, thanks.

 

[DW Team]

I am on Warfarin for my heart condition. I have a total of 13 horses and whilst I am not riding at the moment due to my weight. I would if I was not so over weight (due to the other meds I take). I work with my horses daily and have continued to do all my stable duties. I regularly take my big stallion out to competitions on my own for him to ridden for me in show jumping or dressage classes. Tacking up can be a bit of a nightmare some times as he is a little prone to a nibble when girthing up but so long as I cross tie him I avoid the bruising from nibbles. My husband also was not happy about me working with the herd but I take care and yes you do bruise badly when knocked but you can get the bruises knocking into furniture or the dog jumping up. I found at times I got strange looks from some people with my arms with bruises sure I think some might have thought battered wife! Do as much as little as you are comfortable with. You can’t wrap your self in bubble wrap. You will find cuts take longer to stop bleeding. You will have to have bloods taken regularly to check your levels. I am luck our surgery have finger prick system but some still have to do the needle in the arm.

 

[Bespoke1]

Thanks for that DWTTEAM I just needed to hear it can be done , im feeling a bit fazed by it all and I'm sure there is someone who has some really good tips and advice that you will only know if you have been through it. I have bought a Coaguchek xs metre direct from Roche for£299. so I can check my own levels as have really poor veins.

 

[zigzag]

Don't let your life stop , just because you are are warfarin. You will come up with some spectacular bruises on your legs etc, and will wonder how the hell you got them lol,

 

[blitznbobs]

Im a doctor - and I simply wouldn't do it. If you don't fall off you'll be fine. If you do fall off and bang your head in the process you'll very probably be dead.

That is the risk you are looking at.

 

[Sprout]

I was on Warfarin for 6 months after a DVT.

I was advised not to ride, but I had my children's ponies who desperately needed exercising, so I did ride, and I got a body protector for the first time, carried something stating I was on the meds etc.

It has to be a personal decision, made with your family. x

 

[Mince Pie]

I would strongly advise that you wear a medical bracelet so that everyone is aware that you are on it, also, if you are on a yard, I would tell everyone there what the situation is so that if there is a problem they can be prepared/know what to do.

 

[soulfull]

I've been on warfarin some 15 yrs an riding all that time. Had some spectacular falls including smashing up my ankle really badly
Never had a problem with bleeding. However you do need to make sure

You keep on top of blood tests
Tell everyone at yard how important it is that if you do have an accident and can't tell paramedic yourself that someone does
You could wear a bracelet but probably a waste of time. I work with ambulance service and rarely does anyone check for one

Most important is to have the highest safety standard riding hat ie not just a 1384 with a kite mark, you need a snell standard
Along with body protector, I chose an air jacket

Be careful what everyday over the counter medications you take too

My family and gp do worry but they also know I will never stop riding.

 

[EmmasMummy]

Just digging this up again...I just got a letter today saying they want me back on the rivaroxaban asap. ....but I really don't want to. Although I know it's a choice oof playing roulette with the chance of a clot or with not being able to ride or even ride a freaking bike down a hill.

I hate the stuff ad I am so sore when I am on it. My joints ache and even 20 mins lunging tthe pony I ache for all the next morning and can't take ananything more than paracetamol, which gives me a sore tummy and heart burn.

The consultant has said tho that it's better than wayfaring if you do have a bleed as the antidote they have developed works immediately. ..not like with warfarin.

I've a sore head as I am quite upset.

 

[Darcydoo]

Just to say warfarin is reversed by giving vit K ,quick and simple small amount orally. As Rivaroxaban ect tend to be reversed with FFP infusions ,factor products
dependant on other factors involved.

 

[angel7]

Emmasmummy you don't have to take the rivaroxaban, simply ask to stay on the warfarin or ask for daily clexaine injections. Are you on it to prevent further DVT? or due to Atrial fibrillation?
There is a perfectly good antidote to warfarin - Vitamin K taken orally or IV will correct the INR level within 24 hours.

The risk of bleeding is high around horses and I would think very carefully about what you do with yourself. For example my friend was on daily dalteparin injections following a PE in her lung. She stumbled and caught the edge of a chest of drawers in the tack room, with her left boob. Ouch! at the time but wasn't overly concerned. 1 hour later it had turned into a purple melon twice the size of normal! A and E tested the INR it was fine at 3.0, sent home with no treatment required. 1 week later her chest was very sore and the still purple bruised skin completely broke down. She was left with a 5 cmx 5cm x 5cm deep cavity wound which poured (like a tap) blood/hemoserous fluid for a full 2 weeks. The wound stank to high heaven and has taken months to close, leaving her scarred and lopsided

A lot of doctors have been found to be are putting patients on rivaro for their own financial gain from the drug company. The protocol for its use is very narrow- if you have any liver or kidney impairment you should not be on it atall.

Your risk for major bleeding and/ or injury from a fall while riding also depends on what your target INR is. (this will vary depending on why you need the anticoagulation and different consultants will also have different preferences) For example if your target INR is between 2 and 2.5 and you are stable around this level on warfarin then ask to stick to it, or even swap onto a larger dose of aspirin with some omeprazole for the stomach. If on the other hand your target INR is 4 and you have a fall the consequences would be way worse, I would not be riding if the INR target was 4! If you struggle to maintain INR of 4 on warfarin then ask about daily injections instead.
Rivaroxaban has been touted as the wonder pill for anticoagulation but its side effects are significant as you have found.

Request to discuss your lifestyle with the consultant and ask for the alternatives

 

[Exploding Chestnuts]

Im a doctor - and I simply wouldn't do it. If you don't fall off you'll be fine. If you do fall off and bang your head in the process you'll very probably be dead.

That is the risk you are looking at.

Yes but she will be wearing a good hat, [ maybe get an AP mcCoy type] and a body protector.
I was on it for a bit and no one asked about hobbies/activities. Did mention ambulances and road accidents, to get an antidote if bleeding.

 

[EmmasMummy]

Emmasmummy you don't have to take the rivaroxaban, simply ask to stay on the warfarin or ask for daily clexaine injections. Are you on it to prevent further DVT? or due to Atrial fibrillation?
There is a perfectly good antidote to warfarin - Vitamin K taken orally or IV will correct the INR level within 24 hours.

The risk of bleeding is high around horses and I would think very carefully about what you do with yourself. For example my friend was on daily dalteparin injections following a PE in her lung. She stumbled and caught the edge of a chest of drawers in the tack room, with her left boob. Ouch! at the time but wasn't overly concerned. 1 hour later it had turned into a purple melon twice the size of normal! A and E tested the INR it was fine at 3.0, sent home with no treatment required. 1 week later her chest was very sore and the still purple bruised skin completely broke down. She was left with a 5 cmx 5cm x 5cm deep cavity wound which poured (like a tap) blood/hemoserous fluid for a full 2 weeks. The wound stank to high heaven and has taken months to close, leaving her scarred and lopsided

A lot of doctors have been found to be are putting patients on rivaro for their own financial gain from the drug company. The protocol for its use is very narrow- if you have any liver or kidney impairment you should not be on it atall.

Your risk for major bleeding and/ or injury from a fall while riding also depends on what your target INR is. (this will vary depending on why you need the anticoagulation and different consultants will also have different preferences) For example if your target INR is between 2 and 2.5 and you are stable around this level on warfarin then ask to stick to it, or even swap onto a larger dose of aspirin with some omeprazole for the stomach. If on the other hand your target INR is 4 and you have a fall the consequences would be way worse, I would not be riding if the INR target was 4! If you struggle to maintain INR of 4 on warfarin then ask about daily injections instead.
Rivaroxaban has been touted as the wonder pill for anticoagulation but its side effects are significant as you have found.

Request to discuss your lifestyle with the consultant and ask for the alternatives

I was on the Rivaroxaban as I was still breast feeding when I had first clot. I had a hight dose Vit K when I had my c-section as I bled without clotting (funny its done a 180!).

I had a second episode so they do the test to check if its your blood, and seems it is. I had a few bumps/trips etc whilst on 20mg rivaroxiban and no bruising at all. Same when on 10mg warfarin the first time.
My target inr was 2-3 and it was never stable on warfarin, I was up to twice weekly testing which luckily I was on maternity leave for.

I am trying to make a list of pros and cons for each.

Rivaroxaban I've been told has a better survival rate in the wake of catastrophic injury as they can stop the bleeding almost immediately. More people die from catastrophic injury on Warfarin.
Rban doesn't need a blood test and keeps INR more stable - but then things can be missed.
And yes, there are the muscle pains, but I still ached on the warfarin - but I had lovely codiene for that! And I would have so many things I cant eat - well, I can but very small amounts.No alcohol, no changing in weight ( I did lose half a stone with original clot - after putting back on 3 and it made readings go crazy so I ended up with my INR at 6!) I do admit that my not wanting to be on the warfarin is the constant changing and the blood tests. My docs is 17 miles from my work and only opens at 8:30am and they are horrendous at having times for routine appointments (the only have like 3 hours clinics a day so I used to have to go at 2pm as the only time they could guarantee.

Really need to get the actual readings from the blood tests then I can make a decision. Its a consultant at the Haematology ward who is deciding my care now.

As for the riding, right now I wont be as I am 19 stone - and struggling to lose any (I want to get my thyroid checked!) so it wont be happening any time soon...It just upsets me that I possibly cant ever again.

 

[Ruth17]

Im a doctor - and I simply wouldn't do it. If you don't fall off you'll be fine. If you do fall off and bang your head in the process you'll very probably be dead.

That is the risk you are looking at.

Same here. Having worked on a Stroke ward I've seen dreadful consequences from bleeds on warfarin. It's not worth the risk especially as it's not for life that you need to take it

 

[EmmasMummy]

Same here. Having worked on a Stroke ward I've seen dreadful consequences from bleeds on warfarin. It's not worth the risk especially as it's not for life that you need to take it

It would be for life though, that is what they are saying. Due to a second episode DVT I am in the high risk category so they would want me on it for the foressable future

 

[EmmasMummy]

Just to update incase anyone else searches.
I got my results back and I have Hughes Syndrome.SO, YAY, go me. On the drugs for life double yay!
Ive been reading up and it says hydroxychloroquine, commonly used to treat malaria can be used, so I am going ot ask about this!

 

[Pia77]

Same here. Having worked on a Stroke ward I've seen dreadful consequences from bleeds on warfarin. It's not worth the risk especially as it's not for life that you need to take it

This together with blitznbobs is the best advice on this page. I take my last ride this Sunday and then I go on warfarin as I recently had a stroke and have subsequently found that I have a PFO and thrombophilia; so it's a non brainer...I'm a lifelong rider, a mother of two under 5 year olds and a doctor. I run a small livery yard from home, I bought the horse of a lifetime in June and it's absolutely awful that I have to give him up but this is far from tragic. I am unbelievably, unbelievably (yes, said twice for dramatic effect!) lucky that my stroke has left me relatively unscathed, mobile and now able to communicate at almost full function with my little kids who need me desperately. I have not one single risk factor and couldn't possibly have predicted this. I have lived with these risk factors for 39 years without suffering any consequences. I then had a serious but non lethal consequence this year and I am not taking the risk. This has been a very gentle warning. I'll miss the horses and if I over-think it I'll sob but not as much as I'd be sobbing if this had been a more serious stroke or heart attack or massive PE.
Warfarin is tricky and so it is only prescribed to people who must take it. The consequences of an unwitnessed fall - even with the best hat and body protector - simply aren't worth it. Please think hard on it.

 

[DD]

difficult one this, I can understand the advice to stop riding in case of falls but has any medic said don't drive or get in a car in case of an accident and banging your head?.

 

[EmmasMummy]

difficult one this, I can understand the advice to stop riding in case of falls but has any medic said don't drive or get in a car in case of an accident and banging your head?.

Nope and apparently I do not even have to tell my insurance company! Though life insurance is unafforable at over £100 a month. I have been told I must take anticoagulants for the rest of my life now. They wont change me to malarial drugs and I am now about to ask them to change me back to warfarin from Rivaboxiban as it has horrible side effects for me. Weight gain being one of them, and I now have Neuropathy associated to the Hughes, so exercise leaves me in pain - which means that weight wont go, so couldn't even ride if I wanted to.
Equally as sad that I cannot ride a bike.

 

[TuscanBunnyGirl]

Im on rivaboxiban at the moment due to DVT after knee surgery and havent had any side affects apart from I feel the cold a hell of a lot more I think its much better than warfarin side effect wise

ETA sorry read you last post So totally ignore what I said. Really hope you find a good balance which works for you. Sucks when things you love get taken away from you Hope things settle down

 

[splashgirl45]

i am on warfarin as i suffered with atrial fibrillation 18 months ago.....i still ride but now will not hack out on my own, just in case. everyone at my yard knows and i always wear a medical bracelet except when indoors in the evening. my doctor recently contacted the hospital heart doc to ask if i could come off it and they said as i was 70 they wouldnt be happy, so looks like i am stuck on it for life...it really scared me at first but i would rather enjoy my life as i want to and take the risk ..there's always risk in life, i could fall down the stairs, have a car accident, or countless other risky things....so i choose to continue riding...

 

[Merlod]

Same here. Having worked on a Stroke ward I've seen dreadful consequences from bleeds on warfarin. It's not worth the risk especially as it's not for life that you need to take it

Absolutely, my uncle was on warfarin - he slipped coming home from the pub and died, he was only late 50's. Broke my mum's heart.

 

[splashgirl45]

Absolutely, my uncle was on warfarin - he slipped coming home from the pub and died, he was only late 50's. Broke my mum's heart.

i am on warfarin as it is supposed to stop clots and it has been explained to me that i could die from a stroke ifmy heart goes into AF again so it is supposed to be a preventative medication for me so i am between a rock and a hard place.....i have blood test every couple of months and my inr seems pretty stable....

 

[Nicnac]

It's a personal choice. I am on Rivaroxaban for life after unexplained large Pulmonary Emboli in October 2015. Warfarin doesn't fit in with my lifestyle as don't have/want to take the time/hassle for all the blood tests. Yes there are probably side effects which I largely ignore; yes there are risks but I haven't stopped doing anything whether that be riding, skiing etc. My father is on Warfarin and has been for many years; he stopped skiing when he was 83 - 2 years ago.

I am lucky to be alive after the PE and therefore want to live my life to the full which is my choice. Others may not agree which is their prerogative.