Riding with blood thinners
 

About a year ago, my little brother was put on blood thinners after a heart attack. He wasn't in particularly good shape, but he was moderately active. His main source of exercise was his commute which I think was something like 5 miles each way. He also walked a lot.

He hasn't ridden since then. He wants to, but says he just doesn't have the energy -- this is frustrating him to the point that he's considering not taking any of his medications anymore. I can't remember what they put him on, except I know at one of the drugs is supposed to be a newer one that's pretty strong.

Those of you who ride with blood thinners, how did it affect your cycling when you got put on them, and what kinds of adjustments did you have to make a year or more later?

Didn't affect me. I was very cautious not to push my heart rate and took it easy most of the time. But this has nothing to do with any effect of blood thinner. Also was on beta blockers but I took it easy so the beta blockers did not hold me back.

In the year after my intervention, I rode 2 centuries at very moderate pace. My understanding was that I had to do as much gentle exercise as possible for rehabilitation.

Plavix was my poison.

If he doesn't want to ride but he walks then tell him to walk. Lots of walking is good. I did a 2 hour walk every morning and a one hour walk every evening. It got me very fit.

Sounds like he may be taking Plavix or Eliquis as an anti-coagulant. I would guess he had angioplasty with the placement of a stent(s). The anti-coagulants are necessary to prevent clot formation especially in the regions around the stents. They can cause fatigue. But with all due respect, what can you hope to accomplish asking a question like this on a cycling forum? Your brother is surely under the close care of a cardiologist. Why isn't HE asking his doctor the question?

Survivors of a heart attack are also frequently prescribed a combination of drugs for control of blood pressure and heart function such as a beta-blocker and an ACE inhibitor. The beta-blocker can have a significant effect on exercise performance since it limits the heart rate besides controlling blood pressure.

Finally the damage done to the heart, resulting scar tissue, and loss of heart performance are likely themselves responsible for some or all of your brother's lack of energy and poor cycling capability. I know that the heart damage and drugs combined caused me about a 20% loss in average speed (from 20+ mph to 16 mph) after my heart attack 17 years ago. Nevertheless I feel normal in my everyday activities, and have no problem cycling on a regular basis within these limitations.

The medications prescribed for heart attack patients are critical to their long term survival. I credit them with keeping me alive all these years since my attack. The drug cocktail used by heart attack survivors is very important for keeping the heart from further degenerating due to a phenomenon called "remodeling" which eventually can result in congestive heart failure. I recommend you counsel your brother to work with his cardiologist to tailor his medications in a way that will still be effective without causing him such unpleasant side effects. This is nothing to play around with. Unilaterally changing or stopping one's medication is a dangerous course to embark on with any disease, none more so than with heart disease.

i was on blood thinners, and am still on beta-blockers, channel blockers, ACE inhibitors, hydrochlorothiazide and statins for the past 10 years. all due to high blood-pressure and cholesterol. had quadruple bypass. most of the fatigue was due, i think, to the BP medications.

ride most every day and doing about 9000 miles per year. was pretty fatigued for a couple of years. i think i've just gotten used to it.

In 2009, I developed DVT in my left leg ... chock full of blood clots. I was hospitalised for 2 weeks, and then put on Warfarin for a year.

I struggled with a lack of energy! Imagine walking the length of a 25-metre swimming pool, with water up to, say, about the middle of your chest. That's how I felt doing anything ... walking ... doing anything around the house ... cycling ... Everything felt like a huge effort.

I did cycle ... I worked at building up my distance and we started doing some audax events, but for every one I successfully completed, just squeaking in within the time limit ... there was another one I DNF'd. So maddening. So frustrating.


Finally a year later, I saw a blood specialist who told me I could come off Warfarin ... we're using some other tactics to prevent the DVT (I have a genetic inclination toward it). And what a difference! Within a few weeks I was like a new person ... it was like someone drained the swimming pool I had been walking through and I was finally back on dry land!


Encourage your brother to talk to a specialist and see if there is any other treatment he could be on.

And otherwise ... just little bits at a time. It is good to be up and around and moving. Ever since the DVT, I am supposed to get up once every 30 minutes and walk a little bit. I don't always do once every 30 minutes, but at least once an hour ... plus a little walk in the mornings, evenings, and at lunch. Start with that.

Main risk is bleeding from a crash. Use a really good helmet and keep the rubber side down.

So-called blood thinners should cause decreased energy. But he is likely on another medicine like a beta blocker, which certainly can.

I have been riding on Sodium Warfarin since 1990 after I had the aortic valve I was born with replaced with a mechanical one. The drug does not affect my energy level, and I have never heard of that as a side effect.

Maybe the newer thinners can cause low energy levels. If that is truly the case, he should ask his care provider if switching to Warfarin or some other thinner is a good option. One of the newer thinners advertises that there are no dietary restrictions. There is sometimes a misconception that you cannot eat foods high in Vitamin K (e.g., certain green, leafy vegetables like kale) when on Warfarin since Vitamin K counteracts the drug. That is simply not true. If you eat a relatively consistent diet you should have no problem. It's usually when you make a drastic dietary change that ups your Vitamin K intake that you can drop below a therapeutic level.

Are you sure it's not psychological? Maybe he's afraid of crashing on blood thinners. While there is certainly a chance of exacerbated consequences from crashing on blood thinners, it doesn't necessarily mean the end of the world. A few years ago, someone kicked up a stick into my front wheel as I was starting to power up a small hill. I was doing about 16 mph when the front wheel locked up and I went flying. I smashed my shoulder into the road and my helmeted head scraped the pavement. Split the end of my collar bone. Other than a little extra bleeding that caused minor bruising around my right breast, being on thinners did not make the consequences any worse than they would have otherwise been.

The main reason is to wrap his mind around the problem. From what I can tell, he suspects his doc might be trying to optimize something that is not in his best interests such as advocating an excessively conservative approach to prevent slightly reduce the risk of a medical event.

A cycling list might be a bad place to get medical advice, but it's not as bad a place to get ideas for how to wrap your mind around the problem and what questions to ask. For example, your reply contains helpful information which could guide questions as well as an approach for talking about things with the cardiologist. A lot of medical advice is aimed at people for whom activity is not a priority (or even something that they want to avoid if necessary). So people who do consider it an objective in and of itself regardless of health benefits might have an angle worth thinking about.

Sure, I apologize if my criticism sounded a little rough. I was just trying to point out how important the relationship between the patient and the cardiologist is in situations like this. He really needs to be fine tuning his meds with his doctor. After a heart attack, trusting your cardiologist is paramount. If he doesn't, then he should get another one. When I had my attack (riding, by the way on the wheel of a gorgeous female cyclist), I was treated at a suburban hospital. They saved my life, but after a botched stent placement procedure, I lost confidence in the cardiology practice there and moved to the main Texas Medical Center/Texas Heart Institute, where I should have been all along. It has been clear sailing since.

As Machka I have DVT in my left leg. Four veins including the Femoral are blocked. I have been on Coumadin, Lovenox, and now Xarelto. It hasn't effected my ridind other than being much more careful. Falling/ crashing could be problematic.

I am only on aspirin, however anyone who is on t he stronger blood thinners should be concerned about injuries on the bike and particularly head injuries. Intra cranial bleeding is a danger in crashes.

No worries. One thing I hadn't mentioned was that a big part of my motivation for posting was to figure out how to talk to my bro.

He's not a particularly cooperative patient, and while I share concerns that we're overmedicated as a population and that the side effects of many drugs are as bad as what they're supposed to address, there's a difference between favoring a minimalist approach to treatment and doing something stupid/dangerous. I don't know what it's like to experience these problems or recover from them, but I can bend his ear in a way that the docs and other people won't be able to.

I don't think the anti-clotting affected me. Something has, but I think it is the blood pressure and/or beta blockers that are doing it. Is he on any other meds? I got my beta blocker dose reduced by my doctor and it helped.

At first after the drugs and stents - I hit a brick wall after 10-15 mi of riding. That was very frustrating. Encourage him. I am back commute RT 30 mi. and taking trail rides to 50 mi or more. I am a couple or so mph slower though.

I've been on Plavix, and am now on Coumadin, as is my best friend. Plavix (they also had me nifepidine to help relax the arteries after the surgery to remove the clot i developed in the left brachial artery in my arm) totally killed my energy levels, and the calcium channel blocker was like a governor on my motor, I just could not go hard at all. Once I was switched to Coumadin my energy levels returned, but I do notice I don't recover from hard efforts as well, and I am colder than I used to be.

Is your brother on a true anti-coagulant or an anti-platelet like Plavix?

I found that the Warfarin (Coumadin) "thinned" my blood to "normal" ... I bled and clotted like the average person. So I didn't worry too much about falling/crashing/hurting myself. If the average person isn't worried, why would I be?


When I went off Warfarin (Coumadin), I returned to my normal ... where, if I cut myself, I clot within seconds.

People have different reactions to Warfarin (Coumadin) ... some seem to handle it quite well, others not so much. I experienced quite a few of the Nervous System side effects described in the link below, including fatigue, lethargy, malaise, asthenia, pain, headache, dizziness, and cold intolerance. My menstrual cycle also changed significantly.

Coumadin Side Effects in Detail - Drugs.com

Taken aspirin every day for many, many years. Has no effect on my riding. Have taken beta blockers for many, many years. Has no effect on my riding except that my heart rate is about 20 beats slower than others.

Like Machka I had a big clot in my leg a couple of years ago and was put on blood thinners. Cycling saved my life in a way. One of the signs I was having an issue was difficulty breathing which only occurred during riding. This was due to the clots showering my lungs. I don't recall the thinners making me tired. In fact I had a really productive cycling summer while I was on the meds.

One thought I had re: your brother. Could some of this be mental? I imagine having a heart attack could be pretty traumatic. Has his attitude changed towards other things in his life? Has he lost interest in activities he previously loved? Perhaps he is depressed. I know you say he is eager to start riding again, but sometimes what we say and what we feel are conflicted.

It's important to distinguish between Plavix and Coumadin/warfarin. I'm on warfarin for life. I'm always cold but I don't have any other issues. It sounds as if OPs brother is on Plavix, I don't have any knowledge about Plavix effects.

I had cardiac arrest, Sa node malfunction ( electric) no damage to my heart as It happened on the operating table for something else...
Stent, Plavix, aspirin, my energy is pretty good , I ride as much as I can, I do have larger packs, even racks with packs on most of my bikes, carry some bandages and blood stopping stuff with me, safety first , I might be called a Fred by ignorant people but I have been places you would not believe... plus I am alive! Garmin Edge 500 with cardio chest belt, tells me my HR on the fly. Ride more then ever.

First, I am sure you are aware of this, everyone is different, and so the advice to get the Cardiologist involved is good advice.

I have heart issues, never actually had a heart attack. In fact it was cycling that indicated that something had changed and that I should go to the cardiologist.

I have had a 4x bypass, subsequent stent, and have a pacemaker implanted.
I am on ACE inhibitors, a Beta blocker, a Statin, and a blood thinner.

I have averaged 4k a year since the bypass, and for the most part I am stronger than I was before the surgery.
I cannot ride with the club when they go up hills because I go into heart block, that is why I have the pacemaker, but that is an electrical issue.

My cardiologist is a cyclist and a runner and he is very supportive of my cycling. My wife asked him if I should be cycling and he said that is why we do this, so he can cycle.

I am actually just as fast or faster now because I am getting more blood flow. I honestly do not notice any issue from the meds.

Hmmmm...I thought I might have been imagining it, but for the last few years I have been feeling like I have become somewhat of a "cold weenie." Maybe it's not all in my mind but rather I have developed that side effect relatively recently.

BTW...Did you ever read about how Sodium Warfarin was discovered and how it was once used as rat poison? Interesting story.

I'm on blood thinners, cholesterol meds, beta blockers, and other various stuff.

Just visited my Cardiologist this morning , and he told me it is normal for me to be less strong, less stamina, and more of a tired feeling......

Sucks to get old............... LOL

I would have asked for a second opinion...but you know how that goes.