Cycling while on Anti-coagulant?

Man, I am incredibly frustrated after my recent hospitalization due to pulmonary embolism…at the age of 27, it’s the third time that I had blood clots episodes. After my first provoked DVT post-surgery, the clots seemed to come back every two years. It’s very likely that I would have to be on anti-coagulant (xarelto) for life.

I remember two years ago, I came off a really successful off-season training, feeling super motivated to go into my racing season…Then after a long road trip, I had to check myself in at the ER. Was put on AC for 3 months and didn’t train at all until I was sure the clots were gone.

This year, with covid and working from home, I had been training consistently and feeling super motivated again to push for 4.0w/kg. But again, PE hit me like a cruel joke.

I was wondering if anyone in the forum have been training or racing while on AC. I don’t think I can give up cycling but at this point it doesn’t seem like I could race any crits. Do I only limit all my rides on the trainer? I don’t want to start TT…

I am not looking for medical advice as I have schedule hematologist appointments. Yes I have tested for all common causes for clotting and all negative. I was told to test a few rare genetic mutation down the line…But any advice on what to pay attention to (such as fueling or hydration) while training would be appreciated!

Sorry for the super confusing post. I don’t think I know what I am looking to get out of from posting. Apologize for the venting…

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The have been a few threads on the topic,but I have been on warfarin / Coumadin for about 11 years after a DVT / PE.

I had been racing since the late 80’s, but after my diagnosis, I switched to triathlon. Going elbow to elbow with guys at 30+mph while on blood thinners just seemed like a bad idea. Continued with my group rides, however…I would occasionally jump into a bike race if I felt the overwhelming jones to race, but always a masters race and never participated in a sprint. The ride of gravel racing has let me do more bike racing.

The good news is that you are on a next-gen thinner. Some on the forum have more experience with it than I do, but I believe they will simply skip a day before a race and then resume their regimen. With warfarin, it is much more difficult to monitor / regulate your INR, so skipping doses is challenging.

Have they determined why you continue to have clots? I was diagnosed with Factor V Leiden, which predisposes me to clots. If you have not been tested for that, you absolutely should.

Good luck,…being on thinners hasn’t really altered my lifestyle significantly. Yeah, I moved away from road racing, but I found plenty of other competitive outlets. Definitely no affect on my performances etc.

Feel free to ask any questions!

Emergency Medicine physician here. A few things I’d add, you may have heard some/all of them. Crashing is obviously a concern, the general thinking is that if you hit your head to any significant degree while on an AC you need a head CT. This may never be an issue but it could also lead to a bunch of CTs over time, which is a risk in and of itself (radiation). As the poster above said, road racing might not be the best idea. MTB is obviously going to have some risk as well.

Currently, xarelto and it’s relatives (the NOACs) are harder to reverse than coumadin. So if you go get into trouble with bleeding that could be a problem. This is rapidly changing though and may not be an issue within the next few years. It’s worth talking to your hematologist about stopping a day before a race. The half life of the NOAC is relatively short (as opposed to coumadin) so the strategy of stopping before an event is at least plausible. That is obviously something that you and your personal physician should assess in regards to risk of clot while off the med, residual bleeding risk etc.

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The cause is a mystery really. My first DVT was provoked by the surgery. When I woke up from the surgery I had a sharp point pain but thought it was just a bug bite…until a week later I was immobilized.

After on Xarelto for 3 months, I went to the hospital and wanted to do blood work. The doctor laughed and said most of genetic causes were found among Caucasians and I was young with no history.

After second DVT, the blood work showed negative on all common causes. So I thought as long as I wear compression socks during long car rides and drink plenty of water I should be fine. Apparently not? I am going to have some rare genetic causes tested this time.

Thanks for the reply. Just good to vent it out to people with similar experience.

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Interesting about stopping xarelto for a day for races?! I am definitely gonna ask the doctor about it!

Thank you!

I have been on AC medication for 18 years now for DVT’s in my legs. The last 7 years has been Xarelto. Maybe I haven’t exactly told the doctor that I mt bike, and nobody has ever told me not to, but I have been mt biking the last 15 years and racing the last 7. I am 57 years old. The only problems I have from this, and it’s not proven, is leg cramps on longer rides. I have also taken up gravel and fat bike riding/racing. The one thing that happened when I had a crash and went to the ER for a dislocated thumb and shoulder injury, they were more concerned if I hit my head. They sent me for a head CT before anything else. I don’t plan on letting this issue sideline me, what happens, will happen, and I don’t want to revert to a couch potatoe because of it. I have cu myself many times, especially on the shins as I ride flats with the spikes and it seems like a daily occurance, along with other cuts/scrapes from minor crashes ect. and I don’t seem to bleed excessively because of it. The best choice, maybe not, but a man has to live. I don’t have the crudentials to offer medical advice, just wanted to share my experience with you.

As noted above, the real concern with racing / riding on thinners is a head injury and possible cranial bleed. It was a couple years before that was explained to me…I had just assumed the concern would be excessive bleeding from crash injury (such as a compound fracture or something).

After talking to your doctors about adjusting your dosage, etc. you’ll just need to find the risk level you (and your family) are comfortable with. For me, it has meant pretty much skipping road racing and being somewhat cautious in whatever gravel races I do. But there is no reason why being on thinners should 100% prevent you from racing to some level.

One of the reasons my docs have kept me on warfarin if because it is more easily reversed as the good doc above noted. But there is now a referral agent for Xaralto, I believe (or one of the next-gen thinners). My doc tried to get me on it two years ago, but my insurance doesn’t cover it and I wasn’t gonna drop $300 a month on it!

No comments on racing while on a blood thinner. But have you ever had your vitamin k2 levels checked? K2 it’s vital to proper clotting in the body and the majority of the population is deficient. We get plenty of k1 through plant products but it’s poorly converted to k2. K2 is only obtained through animal products or fermented foods. Mostly cheeses and natto. I’d look into getting tested and or supplementing with k2 specifically one that contains mk7.

Not a doctor but I study nutrition in my free time. Just some food for thought. I wouldn’t be surprised if that had an affect on your frequent issues.

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So Romain Bardet not only had a concussion after his crash, but also a small hemorrhage. As someone on blood thinners, that is very frightening.

Shameful he was allowed to get back on his bike. It was obvious he was in no condition to continue. Reminded me of Toms Skujins at the ToC a few years ago.

Thank you for sharing!!!

My insurance covers Xarelto fortunately. That being said! I have a non-cycling related question…how does being on AC affects your career choice? I was thinking about pursuing a PhD degree next year but I don’t think it’s financially doable if I have to be on AC for life…

@BobR549 love to hear your thoughts as well!

I can dig out all my previous test results but that name definitely sounds unfamiliar to me. I will bring it up with the doctor during my appointment on Wednesday.

It shouldn’t really have any effect. Even if you switch to a plan that doesn’t cover the next-gen thinners, warfarin is dirt cheap. Yes, there is more to manage with it (regular INR tests, slight diet modifications, etc) but it really isn’t a big deal.

Sounds good! Thank you!