You should probably be more concerned about head blows causing internal bleeding rather than chest injuries (although those should still be a concern).

I have been riding on blood thinners since 2009....but avoid MTB riding now. (Not a huge sacrifice since the is very little MTB riding around Chicago). Dunno if a chest / back protector is gonna help that much vs. the discomfort of wearing it. That is a personal call, I guess.

As far as road riding, I simply accept the increased risk...used to avoid group rides, but have gotten past that now. At some point I just decided I was gonna live my life and accept the consequences. I do tend to be a bit more cautious on group rides that I am unfamiliar with or seem squirrelly. In those situations, I'll either ride at the back or just drop out altogether.

I also no longer road race and use triathlons as my competitive outlet....

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Chicago Cubs - 2016 WORLD SERIES Champions!!!!

"If ever the time should come, when vain and aspiring men shall possess the highest seats in government, our country will stand in need of its experienced patriots to prevent its ruin." - Samuel Adams

I have been on Coumadin since 2012 for blood clots and pulmonary embolisms, so since then I have always been very cautious of riding, no more races for me since. Unfortunately I was hit by a large pickup truck back in October last year, the jerk pulled out of a side street and hit me broadside, I suffered a number of broken ribs, broken bones in both knees and one elbow, but the worst has been the bad head trauma, as when I went down, which I remember quite clearly I was saying to myself "don’t hit your head", "don’t hit your head" and then of course bang my head hit the pavement and that was the last thing I remember until I woke up in the back of the ambulance being taken to the ER.
When I got to the ER I was given two CAT scans, plus loads of other x rays etc. but thankfully I didn’t have any bleeding on my brain, and was discharged the next day. Then a few days later I had the post-concussion syndrome kick in, couldn’t walk straight, think or focus nothing I was really affected, so I had another CT scan showed swelling but again no bleeding, then followed an MRI and MRV. So, I guess what I am trying to say very long winded here is yes, I was very careful about hitting my head but in this case I didn’t have a chance, but thankfully my helmet saved my life in this case which was completely broken. My INR at the time of the accident was 2.3, I was pretty banged up all over but no internal bleeding thankfully. I am still suffering bad from the post-concussion syndrome and am far from good yet, but I guess I was lucky with no brain bleed so I guess sometimes you win other times you lose as a good friend of mine just fell in the bathroom and hit his head and died and he was on Warfarin.
As for going back out on my bike I am not sure as I don’t know if I ever what to go through this again, it is a gamble especially being on blood thinners for sure. I am lucky I don’t bleed more than normal but some people can bleed terribly I guess it just depends on your system and how your body works with the blood thinners. Good luck in your choice, up until this accident I loved cycling and didn’t think I would ever stop even being on Coumadin.
On a side note the idiot who hit me has 22 driving convictions and 2 criminal convictions so I guess you never know who you are going to run into on the road!
Cheers LA Rob

+1 to live your life. little more {well alot more} carefull. on xerelto.

My perspective as an emergency medicine physician (still in training):
-keep doing what you love.
-consider staying on a blood thinner that can be reversed. Not all can
-wear some sort of medical alert bracelet or the such so that if you come into the ER unconscious your physician will know what kind of blood thinner you're on.

I would agree with being on either Coumadin or Warfarin both of which can be reversed which is handy in the case of emergency surgery or at least being able to lower the INR level of the blood quickly, this helped me back in 2012 when I needed surgery quickly. I do believe there are other blood thinners coming onto the market that can be reversed but I guess I will stick with the Coumadin for now.

I always wear a red rubber type bracelet which reads "on blood thinners" and the word "Coumadin" unfortunately until I woke up from my concussion when we arrived in the ER no one noticed that bracelet but once I mentioned that I was Coumadin that is when the fun started and the immediate need for the CAT scan and the blood work and x rays.

And yes continue to do what you love out there.. my only reason for being hesitant to go back out on the bike is the accident and post concussion syndrome not so much because of being on Coumadin. Cheers LA Rob

Being in the Trauma business ask your doc
if what your on is reversible and wear a medialert bracelet that says the drug your on!
Don't skimp on the helmet either.

Just finished a 6 month stint on xarelto. Kept up with normal road and MTB riding but no racing. I had some decent wipeouts on the MTB but only enough for road rash and some bruises. Did not seem worse than before taking it. I only do pretty easy xc MTB. I have considered getting some pads if only to avoid getting beat up as I crash often. But this is a skill (or lack of) thing.

Definitely agree with everyone that said to make sure your thinner is reversible. Coumadin / Warfarin is and they recently introduced a reversal agent for Eliquis, as well.

After 7 years on warfarin, my doc agreed to put me on Eliquis now that there is a reversal agent....unfortunately, my insurance covers very little of the cost for Eliquis and it would have cost me $300 / month, so I am sticking with the rat poison.

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Chicago Cubs - 2016 WORLD SERIES Champions!!!!

"If ever the time should come, when vain and aspiring men shall possess the highest seats in government, our country will stand in need of its experienced patriots to prevent its ruin." - Samuel Adams

I've had 2 PE's in the last 1 1/2 years and I'm on thinners for life now. I agree with others that just living your life and getting the most out of it is important. My resolution this year (and I never do resolutions) is to stop being a bitch and just go live. I have become OK with being "broken" and I'm pretty done with it. It sucks having that attitude. I am working toward the mindset of being careful without overly cautious, and recognizing that I likely won't be what I was, but I don't have to be broken. I have started triathlon because racing road in a peloton was something I thought to be too dangerous. Now I'm re-thinking that a little. I'm very careful with who I do group rides with and when there is a bad rider in the group, I am very conscious about where he is at and avoid him. My doctor has actually encouraged me to race again, saying I can take a day or two off of the Xarelto before the race since it is a 24 hour drug and be fine. I am also going to race mtn again, which used to be my primary event. I have wrecked while on the meds and while I bleed a little more, but not bad. I figure mtn is an acceptable risk because if I wreck, it's going to be my own fault, not because two people touched wheels in front of me. Tri seems theoretically safer but I've found triathletes are horrible bike handlers, so that may not be a good argument. I am as careful about my head as I can be and make sure my helmets are in good shape. I didn't know that Eliquis has a reversal agent, I may look into that. The problem is I'm getting Xarelto for free right now, so I may switch when that program ends. Good luck.

When I was on blood thinners after my accident, my doctors basically forbade me from riding. With that said, I know there is some variance in terms of "how thin" they are making your blood. I forget the reference values they were targeting for me - I was on warfarin. I do remember cutting myself shaving a couple times and being shocked at how much more it bled than normal.

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"Non est ad astra mollis e terris via." - Seneca | rappstar.com | FB - Rappstar Racing | IG - @jordanrapp

I remember the same thing shaving when I was in the hospital, but not so bad when I was on the medicine for the year following that (target INR at 2.0). And the general advice was - do what you're going to do, just be careful. I did triathlons, but did not do crits. That was my personal choice where I felt the risk was too high.

Re: different types of racing and their relative safety...

I don't think there is any *safe* type of racing....especially on blood thinners. There may be *safer* types of racing, but even that is subject to your skills and abilities. For me, that meant giving up road racing and taking up tris full time. Sure, triathletes aren't known for their handling skills, but I trust my skills and as a FOP rider, I usually don't have any issues. But riding elbow to elbow with 40 other guys @ 30mph through 90* turns? Pass, thanks. But damn do I miss it....a few years ago I did a couple of training circuit races where I knew the race fields would be smaller and with a decent hill to break things up....was awesome to be back in the peloton!

And the reality is that the most dangerous aspect of racing is likely the training that precedes the competition (at least if yo train outside regularly).

FWIW, I don't even think about being in blood thinners anymore (well, other than still working on not forgetting to take my damn meds....you'd think after 7 years I would remember to take them every night, but nope!)

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Chicago Cubs - 2016 WORLD SERIES Champions!!!!

"If ever the time should come, when vain and aspiring men shall possess the highest seats in government, our country will stand in need of its experienced patriots to prevent its ruin." - Samuel Adams

Hello Power13 and All,

Who uses hand held devices for use at home or traveling like the CoaguChek XS to monitor their INR levels?



My wife is on Warfarin and goes to a clinic each 2 weeks or so for blood draw and monitoring.

A home unit would be more convenient ... and useful for travel.

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Cheers, Neal

+1 mph Faster

We used one with my mother for several years before she passed away. It was awesome! She was barely mobile, my husband and I both work, so not having to get her dressed, in the car, and into a clinic had a major contribution to the quality of all of our lives. Medicare paid for hers but I think it would be worth paying out of pocket if insurance wouldn't cover it. I believe the research shows more time in the desired range with home testing.

I wish I had the home testing unit while on the blood thinners. Having someone drive me back and forth ever two days at one point was awful.

If you can get it,even if you have to pay a little out of pocket, I would get one.

The only bike I was allowed on was a stationery bike when on the meds.

I do. Convenient to know levels (and history of taking them helps too), I am in the 2-3 INR range, and strive to keep it as close to 2 as possible. 1.8 - 2.2 is really my goal, but I'm pretty consistent in my levels

PEs in 2009 and then 2010 so I am a lifer, currently on warfarin. I've raced about 10 halfs and 2 IMs on thinners. I've done big group rides on thinners but don't really like relegating my fate to other folks' bike handling skills, so now it's solo or a small group usually. I ride a CT during the week pretty exclusively and outside on weekends. Yes, there is a risk, but it's an increased risk that we always faced. Friend of mine not on thinners had a solo crash this year, lots of brain bleed, just a risk of what we do, that you have to either accept of not. How much an increase no one really knows, but eventually I decided to do what I loved. Even returned to snowboarding this year (ouch....) I MTB (not very well), trail run, body surf, scuba dive.... Even got a tattoo :) Essentially, life is "dangerous" on thinners, and I'd hate to never ride again, only to fall when getting out of the shower which is much more likely.

And even tris aren's safe. June 2015 another racer hit a barricade, went down bike slid in front of me and I went over. Broken collarbone, 7 ribs and punctured lung, rad rash. I remember hitting my head and ending with a lump, but no diagnosed concussion. Ended up in the hospital for a week with a chest tube. Being on thinners turned out to be a non-issue, but they were more cautious. And I knew my INR was 2 as I tested the night before.

I do not bleed more than I used to, I bruise on occasion, but not that often.

Honestly, being on thinners my life is basically the same as it was before for all intents and purposes. My doc wasn't thrilled that I continued to ride, but in the end it's my call, not his.

I just got my home unit last week after 7 years of going to get my INR checked. After my Eliquis fiasco, I asked my hematologist to prescribe me a home unit (my primary never followed through on my previous requests....he sucks)

Will cost me ~$85 / month, but well worth it to save me from the hassle of regular INR testing.

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Chicago Cubs - 2016 WORLD SERIES Champions!!!!

"If ever the time should come, when vain and aspiring men shall possess the highest seats in government, our country will stand in need of its experienced patriots to prevent its ruin." - Samuel Adams

I'm on xarelto since it came out, see a difference in healing of minor cuts and stuff, and decided to get this http://www.safesportid.com/en/
instead of special protectors and stuff but I ain't doin mountainbiking.
Won't help if there is only a moose crossing once a week.

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-shoki

Been on Coumadin since December 2000 after I got my mechanical aortic valve.

Always wear my helmet, but haven't used any additional protective gear specifically due to the Coumadin.

I have a MedicAlert bracelet that I wear full-time, plus a red Road ID band that I wear when running or riding.

I read this thread with great interest at the various reactions to being on blood thinners. Having DVT and a PE, as well as a genetic make-up that makes my blood clot easily, I too am a lifer on warfarin.

In my opinion, for those who have curtailed activities they truly enjoy in order to reduce the risks associated with injury and bleeding, I would investigate an alternative method of reducing that risk. I would explore with your doctor the reason for a target INR. 2.0+ may be entirely appropriate and necessary and also fine for those who lead less active lifestyles. For those who lead (or want to) more active lifestyles, a lower INR value may be a better balancing of the risks associated with clotting and those associated with uncontrolled bleeding. I have kept my INR in the 1.3-1.5 range ever since my PE. I regularly fly 16 hour long-haul Asia/North America flights and have had no recurrence of the clotting issues. (I also balance these risks through better hydration and activity on the flight.)

I'm not a doctor and not telling anyone what to do with their health, and fully acknowledge those whose situations are different than mine. My point is to talk to your doctors, talk about your bleeding risks, and really determine what YOUR INR should be versus following generic guidelines. There might be some good options for you there.

I agree with you. I imagine you have a very involved and progressive physician. Many docs toe the line and prescribe HIGHLY conservative treatments and stick to the traditional (in most cases) 2-3 INR. Not sayin' it's a fear of lawsuits... but... Personally I think 2-3 is very conservative and likely has a huge fudge factor

I know there is a protocol for 1.5-2, although I have not heard of 1.3-1.5, even though i've been down there myself on occasion :) My problem is I either (1) lie and tell the clinic (i test with the machine 4x / year and report every 4 weeks or so) its' 2.0 or (2) tell the truth about 1.8 and if it happens several times they ask for more frequent testing. (or option 3 is find a doc to sign off on a 1.5 protocol, but to be honest I haven't seen a pulmonologist in probably 4 years)

I haven't met very many docs that actually know what it's like to live on coumadin and actually manage the risks, that's just been my experience.

I think the numbers they pick are to give a safety margin on either side. If your target is 2.0 and you come in a little low or a little high, probably nothing bad will happen. If your target is 1.5 and you come in low, well now the medicine isn't really doing anything.

This gets into the big advantage of the newer blood thinners - which is that changes in your diet don't affect them.

But the risks at 2 are much higher than @ 1.5. It's not a zero sum and higher isn't necessarily better

Trust me once the new drugs have established antidotes (other than eliquis) I am all over it. Until then being able to control my levels (before a race i.e.) is actually an advantage. I am very stable and my diet thankfully does not change my INR much. I basically eat and drink as I like and it stays the same nevertheless

I think Pradaxa has a reversal agent. The real issue for most people is whether or not their insurance will cover these new treatments.